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Mark Andersen

My suspicion flared at a Nebraska Health Care Alliance claim that a state health insurance exchange would outperform a federal alternative.

Exchanges, key to expanding health insurance coverage in 2014, seem strange partners for a campaign led by Republican-leaning Meridian Central Public Affairs and funded by hospitals and insurers. Was this an attempt to protect market share?

My cynicism was naïve.

The 18-page executive summary of a 400-page Nebraska Department of Insurance report released Monday, the result of a $1 million study, hints at myriad project complexities, unsettled issues and momentous implications.

Yes, the Alliance makes an appeal to Nebraska cooking.

"We would trust something closer to home," said Paul Utemark, CEO of Fillmore County Hospital and a coalition member.

But that's a natural reaction to an unfathomable menu of expensive entrees.

Unless the state Legislature acts, Nebraska will default to a federal exchange, and there are too many unknowns to opt now for a chef's surprise.

An exchange could operate like a Travelocity for health insurance plans, permitting customers to compare costs and features. The website would check for widely available tax credits and verify citizenship.

But beware the path to get there.

Some doubt the nation has sufficient Harry Potters to connect computers from the Department of Homeland Security, Social Security Administration, Internal Revenue Service, Medicaid and Department of Insurance -- expecto a disastrum.

Going solo could be especially scary.

The federal government would pay to create a Nebraska exchange, but the state must pay its own way after 2016, an estimated $17 million per year coming from fees on insurers or sales.

Surely, customers will come if they build it?

Provided the insurance mandate is deemed constitutional. Provided implementation isn't delayed.

The Department of Insurance has applied for a federal $5.5 million grant to move forward in planning. It would carry no requirement to actually build an exchange.

Maybe there's a possibility of Nebraska partnering with the federal government.

Maybe Nebraska could let the federal government roll out Windows Vista and then tweak it in Cornhusker version 1.2.

"Our recommendation," said Bruce Ramge, director of the Department of Insurance, "is to continue to monitor this."

The report's overall gloomy tone fits with Halloween, but Jennifer Carter of the Nebraska Appleseed Center for Law in the Public Interest also sees opportunities. This is a chance to make insurance more accessible, she said.

"Other states have taken a more proactive approach and have moved forward," she said.

"Is it likely going to be complicated? Absolutely," she said, "but complicated doesn't equal bad."

More than 200,000 Nebraskans currently lack health insurance, and those seeking it on their own face notoriously complicated paths.

The purpose of the exchange is to give Nebraskans real value for their dollar.

The discussion needs to move to the Legislature, she said, with input from all of the stakeholders sitting down together.

Reach Mark Andersen at 402-473-7238 or


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