By Melissa James, associate director, policy analysis & implementation, N.A.C.H.
One of the major mechanisms for expanding health care coverage under the new health reform law will be the creation of state-based health insurance exchanges. The exchanges will begin to operate in 2014 and will essentially be marketplaces where individuals and small businesses can purchase health care coverage for themselves and their employees.
Although the exchanges will be state-based, the federal government will determine standards for some areas of exchange operations, and may even step in to operate an exchange in a state that opts not to do so itself. Earlier this week I attended a conference at the Department of Health and Human Services (HHS) related to implementation of the exchanges. The purpose of the conference was to give stakeholders a chance to provide feedback to HHS regarding specific issues it should consider as it moves forward with implementing the exchanges.
Secretary of Health and Human Services Kathleen Sebelius opened the conference by emphasizing that exchanges are actually a familiar concept, since they will be similar to how health insurance is currently offered to federal and many state employees. Secretary Sebelius also stressed that exchanges have been promoted by both political parties as a market-based approach to expanding coverage.
Next, a series of panels discussed a number of issues related to exchange implementation, including: how exchanges will meet consumer needs; how exchanges will work for small businesses; how qualified plans offered through an exchange should be designed; how the exchanges will operate; the role of the exchange in promoting quality improvement and affordability; and enrollment and eligibility. Panelists spoke to these issues on behalf of a wide variety of stakeholder interests, including consumers, small businesses, large employers, the insurance industry, providers and states.
Although the views expressed were diverse, there were some common themes that ran through the panel discussions:
- States will need to determine how active a role their exchanges will play in advancing health system reform. Options could range from simply accepting all health plans that are qualified to offer coverage through the exchange, to actively encouraging competition by choosing plans based on price and quality.
- Most individuals are not accustomed to researching and selecting their own health plans; therefore, it will be very important that consumers have access to as much information as possible to help inform their choice. Several panelists noted that consumers may tend to choose insurance based on the lowest premium, when other factors such as covered services and cost sharing for specific services may be more important in the long run.
- States need to develop some way to deal with the likelihood that individuals and families, particularly those in the lower income ranges, may “churn” between public and private health coverage, forcing them to change health plans. Suggestions included streamlined eligibility systems and encouraging insurers to offer both private and public health plans to encourage continuity.
- Choice of provider and ensuring that plans provide an adequate provider network will be critical to consumers. As individuals choose coverage, they will want to know which plans include their current providers; this will become even more important to establish consistency if individuals are forced to move between plans as their eligibility for public coverage or subsidies change.
- Strong national performance standards must be developed if exchanges and consumers are to be able to evaluate the quality of health plans and health care providers. Without such standards it will be impossible to move from volume-based to value-based care delivery.
As HHS and the states move forward with implementation, advocates for children will want to make sure that these and other issues are addressed in a way that considers the unique health care needs of children. What do you see as the most important issues for exchange implementation, and how would you suggest they be addressed?
For more information regarding the health insurance exchanges and some of the important issues for families, I recommend an issue brief recently released by the Center for Children and Families at Georgetown University.
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