Marilyn Tavenner: Better plan design could entice healthy exchange enrollees

Health insurance, pen and stethoscope

The health insurance industry is in good health overall, but work remains to ensure the goals of healthcare reform are realized and the Affordable Care Act markets stabilize.

That’s the conclusion of America’s Health Insurance Plans CEO Marilyn Tavenner, who recently spoke to the Portland Business Journal about some of the challenges facing the industry.

The healthcare reform law has made historic gains in reducing the number of uninsured, she noted, but the industry still must address the affordability issue as consumers grapple with rising deductibles and greater out-of-pocket spending.

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The troubles in the ACA exchanges--with some major insurers pulling back--also mean that health plans must also work with the government to stabilize those markets, Tavenner said. However, she implied that the problem is not as dire as some headlines make it seem, noting that when Medicaid, Medicare and Medicare Part D first started they were followed, similarly, by several years of instability.

One of the most pressing issues, she said, is figuring out how to entice healthy consumers to enroll--and stay enrolled--in coverage. In this effort, President Barack Obama himself has solicited ideas from health insurance leaders as he seeks to secure the legacy of his signature law.

In the effort to encourage enrollment, Tavenner said she is more of a “fan of carrots than sticks.” Thus, she is working with the Obama administration to redesign plans to appeal to younger consumers--such as those that focus on preventive care.

She also highlighted the need to prevent individuals from being able to “game the system” by enrolling in ACA plans during special enrollment periods only when they are sick. Indeed, the Obama administration has taken a variety of steps to tighten restrictions on sign-up periods in response to insurers’ concerns, though some worry this could have unintended consequences.

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