Sebelius talks health exchanges on The Daily Show

Jim O'Neil

When I found out that Department of Health & Human Services Secretary Kathleen Sebelius was going to be on The Daily Show last week, I was really excited. Not just because I happen to think Jon Stewart, The Daily Show's host, is possibly one of the best interviewers working in media right now (despite the fact that he's not really a journalist and the show is completely satirical), but also because I knew that meant issues I cover every week--healthcare reform and insurance companies--were going to be discussed in a fresh manner.

And I wasn't disappointed. In an interview that extended well beyond the typical allotted time (the excess portion was available exclusively online), Stewart didn't allow Sebelius merely to regurgitate her rehearsed health reform talking points. Instead, he almost immediately delved into the recent HHS decision to allow states to determine what benefits health plans must offer to sell plans through health insurance exchanges.

"Because the flexibility should be at the state level," Sebelius explained, "Insurance markets are different and we want to give states, within a framework..." She couldn't finish her thought though because Stewart interrupted, obviously wanting a more substantive answer. "You want me to take it all on," Sebelius said with an awkward chuckle. "I'm not going to."

That's where insurers should perk up. Sebelius clearly is pledging there will not be one federal exchange that trumps state-run exchanges so insurers must pay attention to the exchange-related actions of the states where they do business. For the big insurers, that means simultaneously monitoring several states' activities.

What HHS will do is set the framework, Sebelius said, by establishing ground rules for payers. "Insurance companies for the first time have to play by a set of rules," she said. "No more cherry-picking the market to kick out people who might get sick, for instance."

As she attempted to describe the medical-loss ratio (in layman's terms, no less - good luck!) as an example of the ground rules, Stewart interjected, hitting on one of healthcare reform's biggest problems: much of the provisions are too complicated and people don't understand them. "I've started reading about it and it's so confusing," Stewart said. And regardless of whether you agree with Stewart's political leanings, he is definitely one intelligent man.

Last, but not least, Stewart questioned Sebelius about how a Supreme Court decision, namely a ruling that the individual mandate is unconstitutional, could affect health reform efforts overall. Although Sebelius is confident the mandate will be upheld, she said HHS will pursue alternatives if the agency receives an unfavorable decision. "I think we keep going," she said. "We find ways to encourage people to become enrolled and become insured. And the mandate's the fastest way to do it, and it just says, basically, everybody's got some responsibility. But there are other ways to encourage people to come in," she added.

So what's the upshot here? HHS is taking health reform and its complex, confusing requirements to the states, which means insurers will be operating within several exchanges and their various accompanying conditions, even if the Supreme Court shoots down the reform law. That's a lot of real information for a fake news show. -Dina (@HealthPayer)