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The Associated Press October 28, 2011, 7:20PM ET

Neb. health exchange would need 83K-100K enrollees

As many as 100,000 Nebraskans would need to enroll in a state-based health insurance exchange before the program could sustain itself as required, according to a report presented to lawmakers Friday.

Department Director Bruce Ramge told a legislative panel that 83,000 to 100,000 Nebraskans would need to join the exchange to comply with President Barack Obama's health care overhaul. The state health care exchanges -- one option Nebraska is exploring -- would have to become self-supporting by 2016.

About 205,000 Nebraskans are uninsured, or 12 percent of the population, according to the report. The national average is nearly 17 percent.

The report found that more than one in five Nebraska residents between age 18 and 34 are not insured. Nebraskans in low-income households were insured at lower rates than the state and national averages.

Ramge said insurance officials still are struggling with unanswered questions about the essential health benefits the federal government will require, which is key to calculating an exchange's cost. Ramge said officials should wait to introduce a bill until they have more answers, including the outcome of a U.S. Supreme Court ruling expected in June 2012. Lawmakers are expected to adjourn from their regular session in April.

"We'd hate to move down the road with assumptions that aren't good, make plans, and have to back up and start over," Ramge said. "It would be a tremendous waste of time and resources for the state."

The state-based exchange is one of four options Nebraska is considering. States also can participate in federal or regional exchanges, or a state-federal partnership under which the federal government runs certain aspects, such as electronic record-keeping, while states handle customer service or other tasks.

Supporters of the program have said the Legislature should act before the court rules or it could be left scrambling to meet federal deadlines. If the law is upheld, lawmakers would have to pass a bill in a special session before June 29 to qualify for a federal establishment grant worth tens of millions of dollars.

The report examined whether Nebraska's population could support a self-sustaining health care exchange by 2015, as required under the federal health care overhaul.

Ramge said officials are worried they won't get access to all the information technology services they need to comply with the federal health care overhaul. Department analysts told lawmakers the shortage would cause vendors to focus on states with larger populations, where they can make more money because of the greater demand.

The federal health care law seeks to extend health insurance to more than 30 million Americans without coverage.

The state exchanges are meant to offer a one-stop-shop for Americans to buy health insurance. They must be federally certified by January 2013, operational by 2014 and self-sustaining by 2015.

The exchanges will include income-based tax credits to help pay for premiums.

State officials have said a regional exchange appears unlikely, because each state has different regulations and needs. A regional exchange also could lead to a concentration of jobs in one state at the expense of others.

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