Health Care Reform Title I Exchanges

The opinions int his blog represent my personal opinions only and do not reflect the opinion of Cottonwood nor it’s administration.

I want to talk a little bit about the health care exchanges which will be established under Title I. By 2014 each state is to set up an American Health Benefit Exchange to allow greater access and flexibility for those who are not covered under an employee health plan to purchase insurance. The exchange is a marketplace run by the state which essentially lets individuals and small businesses band together to get the same prices and variety of insurance options which are now only available to large companies who can bargain for lowered rates because of high volume.

I believe that the exchanges are a good idea as it has been very difficult for individuals and small businesses to get affordable health insurance. This is particularly important since the health care reform law mandates that everyone purchase health care insurance. I am very pleased to see that the law establishes the exchanges through the states and not a national exchange run by the federal government. A national exchange was proposed in the previous House bill but was rejected by the Senate. Under the law the states have a lot of flexibility in determining how these exchanges will be run and I think that is a very good thing. There may be better and worse ways of doing this which only time will tell and those ways that work best can the be adopted by other states. In addition each state will be able to continue to mandate certain benefits such as cancer screening tests that are in addition to the recommendations established by the federal government. The House bill had the states required to reimburse the federal government for any additional mandates.

One other positive feature is in the “fine print”. A state run exchange will not be allowed to exclude health plans that are fee for service, will not be allowed to exclude a health plan by imposition of premium price controls, and most importantly to me may not exclude a health plan that provides “treatments necessary to prevent a patients’ deaths in circumstances the Exchange determines are inappropriate or too costly”. I have a big thank you to the Senate for including these restrictions on an exchanges ability to exclude certain health plans.

There is one area that is a bit confusing to me though. That is pages 75-80 which deal with the establishment of a ”community health insurance option”. I have read it over several times but what it seems to be is a modified version of a government run health plan offered through the exchanges. States can prohibit this offering or “opt out”. The community health insurance would provide coverage for only “the essential benefits”. Any additional coverage through state mandates would have to reimbursed to the federal government by the states. I will have to talk with other people about what this community health insurance option really is.

So, overall I don’t really have many objections or problems in how the law establishes the American Health Benefit Exchange. The only problem I see is that the same issues I talked about yesterday apply to any plans under the exchange as well.

Thought for the day

I am grateful for the sunshine today.

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