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Health Insurance Exchange: the Pivotal Factor to Reform Success
Written by David Norman
Monday, 12 October 2009 20:29
Beyond the heated, emotional debate over the public option, the foundation of health care reform does not lie in creating a universal, federal health care giant. The most significant difference, the one that would make the main shift in the health care industry to becoming patient-centered under the current proposed bills, is the exchange.
The solution offered by Senator Baucus’ and President Obama’s plans is “managed competition,” or the health insurance exchange, a flexible outline for an entity that moderates insurers and offers a variety of plans to enrollees. Despite the fervor that conservatives and insurance companies have tried to cook up, this idea is nothing new. It originated in the 1970s, and was included in President Clinton’s 1993 Health Security Act, under the design of managing competition only in regional and corporate levels. Massachusetts has been often cited as a paradigm for the success of exchanges, and some states have implemented similar programs where residents can compare costs of specific services under different insurers and providers.
Under the current system, the insurance market is controlled jointly by insurance companies, and to a lesser degree, employers. Insurers set premiums, define coverage hidden in mounds of technical documents, but ultimately health care packages get filtered even more by the heavyset employer-sponsored sector of insurance. Many small and medium-sized employers, due to the high costs of the current system, offer no coverage or have sharply cut back in recent years, and then even larger organizations cut packages down to lower-level employees, turning health care into a reward for their most qualified employees.
These two factions control how almost all Americans get health care. This leaves most of those trying to purchase insurance through non-group market to face extremely high costs. Studies find that 83% of the uninsured are workers and their dependants whose employers do not offer coverage or whose options are too costly or too limited in coverage. As of 2005, 21% of uninsured workers say they declined employer-sponsored insurance packages because of costs. Likewise, public programs like Medicare and Medicaid are held to rigidly-defined groups of people for specified services, the parameters of which can only be changed through legislation.
The exchange would essentially be a marketplace displaying a wide variety of insurance packages for individuals that would be monitored by a sponsoring body (the “Health Fed” as it is called) that represents individuals, negotiating with insurers to drive them to competition, aimed at providing the best options to individuals. This design would include areas for customer feedback on specific plans, benefits specifics, information on specialized programs, and general quality of care measures. It could be designed on the national or state levels, or some combination of the both.
The purpose of the exchange, besides providing a single source for information on health care packages and thereby lessening the complexity tied to consumer misinformation in the current system and allowing consumers ease in comparing plans, would be to enforce certain rules of participation on insurers. The largest point in these rules is that insurers participating in the exchange would be required to accept any individual wanting to purchase. This means no one could be excluded from health care due to pre-existing conditions and insurance companies could no longer use avoiding risk as a means of dividing up coverage and care. Combined with an individual mandate, which is discussed below, insurers would be required to lower costs to fit low-income individuals by being required to provide for them.
However, for those who still find insurance too costly or whose regions lack many insurance companies, fall-back options would be created, as well. This would largely be comprised of a public option, but could also include chartering insurance company chapters to areas with few existing options. The public option could be confined to this – limited to those who need it the most – or it could be accessible to all. Its existence, however, is crucial as it is the only new body that could without doubt drive insurers to competition. Tax credits and other subsidies would be offered to those who qualify to ease the burden of insurance premiums, as well.
Such a fall-back would be necessary as the exchange method could not succeed completely without the implementation of a mandate, as is seen in Senator Baucus’ plan. This, combined with a federal competitor, is necessary to creating a wholly competitive market, for without it, insurers could not affectively be required to provide coverage for all. Large amounts of people opting out of the exchange would raise premiums for those with coverage, making more people less willing to purchase insurance plans, leading to a downward cycle.
Though it is highly criticized, the individual mandate is no different than the 1965 decision requiring all workers to subsidize Medicare beneficiaries. A proposed employer mandate, though less controversial, would only wind up being a more costly individual mandate cropping out the uninsured, as employers, in order to balance costs and comply with the mandate, would simply lower wages or other benefits to make up the difference.
Ideally, through a mandate and a singular moderating body, insurers could be moderated to not allow high fluctuation in premiums. The exchange would also allow for standardized coverage, as too much variation makes it difficult for regulators to determine a plan’s compliance and value to the consumer, allowing insurers to slip by with lowered coverage. This would ultimately give the consumer the upper hand, allowing individuals to see all plans available to them on an even playing field. The end goal of all of this would be an industry that works solely for its enrollees.
Last Updated on Wednesday, 28 April 2010 11:58