Health insurance exchanges: Open marketplace

by August 15, 2011
Health insurance exchanges

The Center for Budget and Policy Priorities offers research and analysis of the health care exchange concept.

Last week’s appeals court smackdown of the individual health insurance requirement that was a key part of 2009 health care reform is a new milestone in the ongoing health coverage saga.  Combined with the need for back-to-school physicals, looming open-enrollment season in some health care plans and other news pegs, it makes now a good time to take a look at any of the myriad business angles to health insurance coverage in your region.

First, here’s The Atlantic’s Andrew Cohn with an interested legal / political breakdown of the decision by the  11th U.S. Circuit Court of Appeals in Atlanta; if you’re in need of a further brush-up on the issue, here’s the Washington Post’s Ezra Klein explaining how the individual mandate would work.

One potentially fruitful spin-off from the latest increment in the court fight over requiring Americans to purchase health insurance is a fresh look at the progress and implications of the state health insurance exchanges that were called for in the 2009 Patient Protection and Affordable Care Act.

Ironically, even as the appeals court was nixing the individual policy mandate last week, the U.S. Department of Health and Human Services awarded another $185 to states to help with the building of the exchanges. Here’s the HHS and Treasury department joint press release touting the awards and outlining proposed guidelines for the exhanges; note that it also promotes some upcoming public forums in cities nationwide; you might want to check for one in your vicinity.

Even without a federal mandate for coverage, consumers no doubt will welcome a health insurance marketplace that isn’t shackled to employment and that hopefully will promote competitive pricing and product structure.  But the movement also stands to open a new market for private insurance companies, too; this pre-reform LA Times article on lobbying for the mandate offers good background and stats.  And here’s a more recent Bloomberg BusinessWeek article along the sames lines. You might consider a reaction round-up from insurance executives in your region to the appeals court decision, for example.

The Washington, D.C.-based Center for Budget and Policy Priorities has done a great deal of research and analysis of the health care exchange concept and may have analysts willing to speak to you about conditions in your state.  Also, check out the CBPP’s June 15 presentation, “Health Insurance Exchanges:  State progress in authorizing legislation and and analysis of exchange governance issues” (PDF) for helpful background.

Note the key topic areas of the presentation, including conflicts of interest, role of brokers, etc., all are good fodder for interview questions for officials and insurance company execs in your state.  And here’s a five-page (PDF) CBPP-prepared resource list on health insurance exchanges that also should prove helpful.

It seems to me that there will be a good deal of spin-off business generated by the health insurance exchanges, from marketing and advertising to legal consulting to IT services, if not third parties to run the entire thing.  This Illinois request for proposal, for example, solicits bids for the technology to run that state’s health exchange.  Other states appear to have held public meetings to review vendor pitches. Ask the officials in charge of your state’s exchange for copies of all RFPs and bids available; you can mine them for cost information, jobs potential, interesting contract angles and even business profiles.

Also, myriad professional and trade magazines related to the health care and insurance industry are another source of insight into the gyrations of mandated coverage; here for example at Health Data Management are several articles about health care reform, insurance exchanges and other timely topics.