Exchanges won't likely resemble the Massachusetts version

Although Massachusetts has served as a role model for many aspects of the federal health reform implementation, most states' health insurance exchanges won't resemble the version in Massachusetts.

That's largely a reflection of the insurance industry's political clout and its successful lobby of the Obama administration to drop key features of the Massachusetts Health Connector, including a competitive bidding process that promotes cost-efficient plans and standardized benefit packages, reported the Boston Globe.

The U.S. Department of Health & Human Services will run online marketplaces in 34 states, where it will maintain a weak gatekeeper role, FierceHealthPayer previously reported. "The insurance companies want the exchanges to be weak. They don't want the exchanges to negotiate with plans, to establish a competitive bidding process, to standardize the benefit package," Jay Angoff, former director of the HHS Office of Consumer Information and Insurance Oversight, told the Globe. "They want to be able to sell whatever policies that meet the minimum standards of the statute and to charge whatever they want."

But insurers say that providing greater consumer choice and enhanced competition motivates their actions. "We want to make sure this transition is as smooth as possible for everybody, and that costs don't go up too much," said Robert Zirkelbach, spokesman for America's Health Insurance Plans. "If you limit the number of plans, you're not going to get the desired result."

Angoff still believes, however, that "it's a big mistake for the exchanges not to use their bargaining power" right away. "If companies' benefit packages are all over the lot, the consumer really can't tell what's the best value. A weak exchange is really defeating the main purpose of establishing exchanges to begin with."

Indeed, some in Boston are disappointed by the weaker role that HHS will have in exchanges. Amy Whitcomb Slemmer, executive director of Health Care For All in Boston, told the Globe that many healthcare advocates wanted a standardized approach to promote "apples to apples" comparisons. "We are frustrated by some of the compromising that's going on in the implementation process, and we hope state advocates really push for more regulatory teeth in the exchanges," Whitcomb Slemmer said.

But Jon Kingsdale, former head of the Commonwealth Health Insurance Connector Authority who now consults with other states to develop exchanges, said that despite some weaker consumer protections, the delays say "nothing about the intent of the federal government to weaken the scope of health reform." He added that "2014 is the start…It's not the finish line."

To learn more:
- read the Boston Globe article