|Implemented in this survey?|
Health insurance exchanges were invented to improve accessibility and portability of health insurance. Although the health insurance exchange concept has existed for over a decade, their popularity increased dramatically as a central feature of most 2009 US health reform proposals.
Health insurance exchanges (HIE) were created to improve the accessibility and portability of health insurance. During the United States 2009 health reform efforts, health insurance exchanges have been included in most legislative proposals. They are a way for individuals that historically have purchased insurance individually to purchase insurance as part of a group and to have many different insurers compete for their business.
The meaning of the term 'health insurance exchange' varies widely and has been used to refer to everything from an information clearinghouse to a highly structured intermediary that contracts with health plans and negotiates benefit packages. In most recent formulations, a health insurance exchange involves a regulating entity (e.g. a state or organization) that contracts with a number of competing health plans based on minimum standards for what constitutes creditable coverage. This entity then negotiates benefit packages and cost sharing requirements with each contracting plan. In most cases an exchange would also regulate the insurance market by setting rules regarding underwriting and rating practices. Individuals then choose among the competing plans.
Most proposed HIEs target small businesses (usually those with less than 10-20 employees) and individuals purchasing insurance on their own who have been unable to obtain affordable health insurance on the private market.
The purpose of the health insurance exchange is to improve access to, and portability of, health insurance. The goal is to allow the private market to work by having the information presented in an easily accessible way.
Health insurance exchanges are usually formulated so as to encourage competition among insurance plans (both local and national plans), with the expectation that it will lead to greater efficiency and lower costs to enrollees because of greater competition.
Government, Insurance companies, Employers, Patients/Consumers, Uninsured, Providers
|Medienpräsenz||sehr gering||sehr hoch|
The final legislation will heavily influence the structural impact and transferability of the policy.
In their most basic form, health insurance exchanges have been discussed in the policy realm for over a decade. However, the 2008 election cycle (and coincident world-wide recession) brought national attention to the number of uninsured individuals and the high cost of insurance on the individual and small group market in the United States. The election of President Obama and a majority of Congressional Democrats changed the political direction of the U.S. to support health reform.
Health insurance exchanges have gained wider recognition and visibility as part of a strong commitment by the Obama Administration to work towards increased coverage of the uninsured. Health insurance exchanges are now viewed as a central component of addressing the 46 million uninsured and 25 million underinsured persons in the United States.
The election of President Barack Obama in 2008 and a Democratic majority in the US House of Representatives and the US Senate, has contributed towards an increasing emphasis on health care reform.
Members of both the Democratic and Republican parties have expressed support for expanding health insurance coverage to all Americans.
|Implemented in this survey?|
Various forms of health insurance exchanges (HIEs) have been developed and implemented at the state and local level in recent years. Current proposals are based primarily on the health insurance exchange created in Massachusetts. In 2006, the state of Massachusetts passed reform legislation that included the creation of the Massachusetts Health Insurance Connector Authority - a body that operates two health insurance exchanges in the state. Low-income residents have access to Commonwealth Care, a HIE that provides a choice of health insurance plans at subsidized rates. Higher income state residences have access to Commonwealth Choice where they can choose between a number of health insurance carriers and benefit packages. The Massachusetts legislation included two other important features: an individual coverage mandate requiring most residents to obtain coverage and a 'pay or play' feature where employers with 11 or more employees are required to either provide coverage for their employees or pay a penalty.
Recent national health reform proposals put forth by the Senate Finance Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee as well as legislation in the House of Representatives include HIE mechanisms.
The Senate Finance Committee's proposal would create a system of state-level HIEs that would be accessible to uninsured individuals and a small group market HIE that would allow small businesses (up to 100 employees) to access coverage for their employees. This proposal would also require guaranteed issue and renewability (regardless of health status), but would allow rating variation based on certain individual characteristics including age, tobacco use, geography, and family composition.
The Senate HELP Committee's proposal would create a system of state-level HIEs where a governmental agency or non-profit organization would serve as the regulating entity. These HIEs would be accessible to only to those individuals that do not have creditable coverage available to them through their employer or through a government program such as Medicare or Medicaid. Like the Senate Finance Committee's proposal this proposal would also require guaranteed issue and renewability, and would allow rating variation based on certain individual characteristics.
The House of Representatives proposals are similar to the Senate versions.
The approach of the idea is described as:
renewed: Health care exchanges have been discussed in various incarnations in the US for many years. The most recent debates propose exchanges as a way of improving accessibility and affordability of insurance plans for individuals and small businesses.
Local level - The Massachusetts Health Insurance Connector Authority operates two health insurance exchanges in the state.
The concept of health insurance exchanges is well accepted within the health reform debate. However, a great deal of debate occurs over the details of how the exchanges would be formulated. In general, Democrats support HIEs that regulate the insurance market tightly, including eliminating prexisting condition exclusions and requiring guaranteed issue and renewability. Some Republicans want a single health insurance exchange for all individuals, where employers would contribute a certain fixed sum toward purchasing a plan and employees would pay the difference for their plan of choice. In this manner competition would be increased while abolishing the current employer tax treatment of health insurance.
|Obama Administration||sehr unterstützend||stark dagegen|
|Health care providers||sehr unterstützend||stark dagegen|
|Consumers||sehr unterstützend||stark dagegen|
|Uninsured||sehr unterstützend||stark dagegen|
|Privatwirtschaft, privater Sektor|
|Insurance companies||sehr unterstützend||stark dagegen|
|Small business owners||sehr unterstützend||stark dagegen|
|Democrats||sehr unterstützend||stark dagegen|
|Republicans||sehr unterstützend||stark dagegen|
Health insurance exchanges are folded in with other elements of the 2009 health reform debate in the U.S.
|Obama Administration||sehr groß||kein|
|Health care providers||sehr groß||kein|
|Privatwirtschaft, privater Sektor|
|Insurance companies||sehr groß||kein|
|Small business owners||sehr groß||kein|
The government agency or third party that would serve as the administering entity will be the primary actor in the implementation and formulation of the health insurance exchange(s). The potential barriers and incentives will depend on the details of the overall health reform bill eventually passed.
The current health reform proposals that include health insurance exchange(s) do not currently propose monitoring or evaluative mechanisms.
The final formulation of the legislation, and the exact regulatory mechanisms put in place,will affect the outcome of the health insurance exchanges. As implemented in Massachusetts, the health insurance exchange has helped to significantly reduce uninsurance rates, however, at this time insufficient data is available on the overall success of the program in terms of affordability and portability of insurance purchased within the exchange.
Depending on the formulation, it is possible that employers will cease providing insurance as part of their benefits package and leave employees to purchase coverage within the exchange. In addition, without strict regulation, the health insurance exchanges may have little impact on existing problems with the individual and small business insurance markets.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
If the final legislation is formulated to promote plan competition such that consumers have more affordable choices, the plan would improve equity and cost-efficiency.
Emily Adrion, Krista Harrison and Gerard Anderson