The board of the Health Benefit Exchange is going to be small and mighty.
It will be responsible for implementing the first, and probably largest, health insurance exchange in the nation. This exchange will concentrate the health insurance buying power of millions of Californians, and will be the central force in implementing national health care reform in California.
It will be run by five people. Three of the board's members are in place. Former Governor Schwarzenegger named two of them: his chief of staff Susan Kennedy, and the former Secretary of Health and Human Services, Kim Belshé. The third member, by statute, is the current head of CHHS, Diana Dooley, appointed CHHS secretary two months ago by Governor Brown.
The last two spots are the responsibility of the heads of the Assembly and Senate -- Assembly Speaker John Pérez and Senate President Pro Tempore Darrell Steinberg.
Dooley recently said the appointments have to take a back seat to finishing the budget, which is expected to be finalized by the start of March.
But delaying the appointments does not mean anyone is ignoring them. According to Sumi Sousa, the health care adviser for Speaker Pérez, the search has been active and ongoing.
"I helped put the conflict-of-interest guidelines together, and I'm kicking myself a little now," Sousa said with a smile. "Because it's almost impossible to find an ideal candidate -- they need to understand what's in the [health insurance] market, while not having a conflict of interest."
However, she said, the choices have been significantly narrowed down at this point, so once the budget is worked out, the focus can shift to appointing the exchange board members.
"They will be named fairly quickly, I think," she said.
Part of the rationale for having a small board, Sousa said, was because the exchange board will sometimes need to make decisions quickly.
"It was pretty clear in terms of the exchange itself, it needed to be agile and flexible," Sousa said. "We needed to figure out how this exchange is going to deal with this outside market, so it needed to be flexible but also transparent, because every single thing about the exchange will be public."
The exchange board will have a full plate from the beginning, Sousa said. She some advice to advocates and legislators: "There will be many bills that want to give more authority to the exchange, to enroll more people, for instance, and the one thing we risk is if the exchange can't get its core functions done," she said.
"If we can't walk [first], that would be the thing, that would be our central legislative challenge," Sousa said. "We all want so much to do everything we can. And the challenge is to step back, and to let the [exchange] board be a little insulated from the rough and tumble of the Legislature."