Increasing Number Of CNMI Residents Lack Health Insurance

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Territory preparing to implement Affordable Care Act provisions

By Moneth Deposa

SAIPAN, CNMI (Saipan Tribune, August 1, 2013) – A large number of the Commonwealth of the Northern Mariana Island’s residents, including many from well-to-do families, do not have any health insurance, according to Commerce Secretary Sixto Igisomar, who is also the CNMI’s state insurance commissioner.

He said that based on the 2010 Census, more than 18,000 individuals do not have private insurance and are not even covered by the government-run Medicaid program.

This is 33 percent of the CNMI’s 53,800 population.

This figures is believed to have grown since then, according to the Commonwealth Healthcare Corp. (CHC) board, as a result of increasing premium rates and economic hardships suffered by families.

Saipan Tribune learned that the 18,000-plus uninsured come from a broad cross-section of CNMI society, including children and adults from well-to-do families, the working class, and the indigent sector. The total also includes nonresident workers on the islands. The census, as described by Igisomar, was a full count as this was based on house-to-house visits.

Dr. Sherleen Osman, director for Medical Affairs, believes the actual number of uninsured individuals is much larger, based on her conversations and personal knowledge about many patients.

The issue came about as the Commonwealth prepares to implement applicable provisions of the federal Patient Protection and Affordable Care Act, more commonly known as Obamacare or Affordable Care Act. It was signed into law in March 2010. Its intention is to insure all Americans and reduce the costs of healthcare. That includes regulating the premium rates of health insurance carriers.

This law includes numerous provisions and policies that are being challenged by many states. Many insurance companies have also expressed opposition to Obamacare, hinting that if implemented in its entirety, it will create a potential loss of health insurance carriers that can provide services to people.

In the CNMI, Igisomar said that at least five insurance carriers will be impacted by the Act.

One key component of the law is the "Exchange" which was put in place to mitigate the adverse impact of lowering premium rates by pulling carriers together. The CNMI, however, has opted out of this.

"Yes, we never applied for the ‘Exchange’ because there’s a risk for the CNMI because if you apply for ‘Exchange’ and you do not implement it, the CNMI has to pay back all monies it received," said Igisomar.

He also pointed out that no territory tried to do the same for fear of this risk. Exploring the idea of a "regional type of Exchange" was not even endorsed by the U.S. Department of Human and Health Services, which is directly involved in Obamacare.

As far as Igisomar’s office is concerned, the CNMI has to date received funding from Obamacare totaling to $3 million: $1 million was approved for the first grant, the amount of which is about to be exhausted; and $2 million for the second grant, of which more than half have yet to be expended. The CNMI expects to avail of another $200,000 soon.

As to how much money will actually flow to the CNMI under Obamacare, Igisomar said he does not have the figure yet and where the money will go. However, he cited the $75 million that territories will share for their Medicaid program.

In the CNMI, the sharing for this federal-state program is 45-55 percent and disbursement depends on the CNMI’s ability to come up with its matching fund.

Market reform

Igisomar said that one of the challenges the CNMI faces is its ability to enforce market reforms under Obamacare. Some examples of these market reforms are pre-existing conditions exclusion; fair health insurance premium; guaranteed availability of coverage; non-discrimination in healthcare; and many others.

The U.S. Department of Human and Health Services itself has already asked the CNMI if it can implement the Act.

Igisomar said he recently received a letter from HHS with the specific question: "Can you enforce it [market reform] or not?"

Igisomar said he plans to respond that: "Yes, we can. But we are asking assistance to mitigate the impact."

This position, expected to be formalized on Aug. 12, was supported by the HHS, according to him.

Igisomar plans to meet Gov. Eloy S. Inos soon to discuss the "direction" that he wants to pursue in Obamacare’s implementation.

According to Igisomar, the CNMI recently hired Kaitlin Mocane to do public education about the Act for people to better understand the law.

Igisomar made his presentation yesterday to the CHCC board, focusing on the regulatory side of Obamacare and its impact on the CNMI.

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