Bobbette Bond is in the middle of a grand experiment, so you could say she’s pretty busy.
Bond is chief project officer of the Nevada Health Consumer Operated and Oriented Plan, an insurance nonprofit scheduled to launch this fall on the Silver State Health Insurance Exchange. It’ll be the state’s first CO-OP, a type of member-run insurer created under the Affordable Care Act, and that trailblazing means plenty of 14-hour days as the company prepares to sell its plans beginning Oct. 1.
But Bond wouldn’t have it any other way: She dreamed as a college student of improving access to health care, and has spent much of her career as a health care advocate for labor unions. She called getting Nevada Health CO-OP up and running a “once-in-a-lifetime” experience, both for the sheer volume of work it’s taken to start up, and for the opportunity to help others.
The CO-OP will be available to all Nevadans, but Bond said she expects small businesses and individuals who want homegrown health insurance to make up a big portion of the nonprofit’s members.
Question: Why did you choose a career in health advocacy?
Answer: When I was in second grade, I wanted to be a nurse. But by the time I got to college, I was interested in health care in general, so I got my bachelor’s degree in community health.
Then I was fortunate to attend the master’s program in Chapel Hill, N.C., and it opened my eyes to how vast the health care world is.
So I moved from a clinical orientation to a more global outlook. Early on, I was very much about what things people most need in life, and health is right up there as one of the most important things you have. It’s the baseline for everything else.
Question: How will the CO-OP differ from other insurers?
Answer: We’ll be the only nonprofit health plan on the exchange. We’re the only plan focused 100 percent on not having to worry about shareholders, which gives us room to spend all of our resources on our members.
We have a small margin of profit, and we don’t have to add shareholders onto that.
I don’t want to be too negative about shareholders, because they do keep companies running, but this gives us an asset other companies just don’t have.
Also, we’ll be governed by a board that’s mostly made up of consumers. We’ll have some consumer representatives through our consumer advisory board, which will include community leaders who have experience working with underserved populations. And we’ll fill the board with actual members so we have them represented.
We also have five advocates whose whole job is to work during intake with members, to help them get oriented to their health care plan and the system. The hardest thing about health care is the complete fragmentation of it. You have to wait for your appointment, wait for your prescription card, figure out how to deal with the pharmacist, figure out if your benefits cover your procedure, wait for test results, and go get an X-ray somewhere else. You have these isolated pods of care. So we’re going to help people understand how their benefits can help them through the system.
We have a lot of experience with coalition-building and management. One of the exciting things for me is my advocacy role.
More than taking care of people, it’s empowering people, giving them the skills and knowledge they need to grow and contribute. The CO-OP is about that. It’s not a care-taking mission. It’s an empowerment mission.
Question: What is the toughest part of setting up a health insurance company?
Answer: It’s been the vast diversity of the components.
I’ve underestimated what a small-business entrepreneur goes through to create an organization — making sure you have workman’s comp insurance, signing the lease, finding furniture, setting up payroll. I’ve developed a huge respect for people who build their own companies.
I really hope the CO-OP ends up helping small businesses.
Also, even though the state exchange is doing a great job, there are so many unknowns in the Affordable Care Act. You’re constantly just guessing on some things. Will plans be affordable? Will people accept the exchange?
Question: What’s a typical day like for you?
Answer: We have a leadership call every morning at 7, and an all-staff call every morning at 8 to check on the top issues.
We’re frantically working to get customer service set up now. We’re probably two-thirds into our implementation plan.
The whole staff works 12- to 14-hour days. We have 20 employees now and we add a person a week. So we’re onboarding those people and building our customer-service capacity and making sure we can effectively interact with the state exchange and its systems. We’re also trying to figure out our media campaign on a limited budget.
Question: Will you be ready to go on Oct. 1?
Answer: We will. And then we’ll be working to get a presence in rural and Northern Nevada.
Our first enrollment cycle will run through March, and we’re going to need all six months of that to get up to speed. We were initially expecting 30,000 enrollees in our first year, but with the delay in the employer mandate, we’re not sure if that estimate will change.”
Question: Each time a part of the law is delayed, opponents say we should scrap it and start over. Do you agree?
Answer: I think they passed a really complex law really quickly. I also think there are some good things about the Affordable Care Act, and there are some huge challenges with it. Delaying the employer penalty sure came out of the blue. We’re navigating rough waters, and it could go any way at all. We’re not sure what we’re in for. I wouldn’t scrap the law and start over, but I do think there has to be a really clear process for solving problems that arise out of its complexity.
There’s no clean process in Congress to fix things.
Also the Culinary Health Fund is really happy to sponsor the CO-OP, but self-funded health plans are in many ways disenfranchised by the law.
You can only operate on the state exchanges if you’re licensed. That limits the churches, nonprofit health plans and union health plans that are a huge part of the market.
We don’t know what the ramifications will be.
And I don’t think anybody knows what the impact will be of changing the essential health benefits that are required, and of having different banding (insurance ratings based on health status). But I do think the marketplace is ideal for young people. They’ll get choice and variety. The CO-OP is great for them too. We’re attractive to anyone who wants to do business with a homegrown company that’s focused on its mission instead of the market, or who wants to buy local.
Question: What has been your biggest career accomplishment?
Answer: Ask me in January! Actually, it’s getting this far with the CO-OP.
Question: What are you watching as far as how the law affects health care?
Answer: I’m really interested to see how much all of this work on the state exchange reduces the number of uninsured in Nevada.
We have one of the highest rates of uninsured people in the country, and we have so many quality-of-life problems because of problems with health care access. I think it’ll be a big deal to look back next year and see what we’ve accomplished as a state. We’ve expanded Medicaid, we have CO-OPs and we have a state-run exchange, and we have all of those things with a Republican governor. Nevada’s very unique. We’ve got more than 500,000 uninsured residents (or about 22 percent). Even knocking that in half, to 10 percent uninsured, would be huge progress.
Contact reporter Jennifer Robison at firstname.lastname@example.org or 702-380-4512. Follow @J_Robison1 on Twitter.