Editor’s note: Karen Davenport will be at OSI-Baltimore for a forum, Keeping Up with Changes in Health Reform: Health Insurance Exchanges in Maryland, on Thursday, July 21st.
Early last week, the US Department of Health and Human Services issued draft regulations on health insurance exchanges—the new health insurance marketplaces, established under the health care reform law, that are intended to give individuals and small businesses a new and better way to find and purchase health insurance. These regulations give the states the parameters they can use as they establish and operate these exchanges. As drafted, these rules will enable states to take an active role in creating this insurance market—but they also enable states to take a laissez faire approach to health insurance exchanges if they so choose.
Health care reform is, in many ways, health insurance reform. Some of the first changes to take effect under the Affordable Care Act were new rules for health insurance plans, such as prohibiting them from rescinding coverage after an enrollee has already been paying premiums, and eliminating lifetime limits on health insurance policies. The state-operated health insurance exchanges will be a lynch-pin in health insurance reform, providing a structured and transparent marketplace for health coverage, in contrast to the hard-to-navigate, dysfunctional and discriminatory markets present in so many states today. But exchanges will work best if states seize the tools they have been handed by the new law and these new regulations, using them with determination and vision to fashion an insurance market that holds insurance plans accountable, emphasizes high-quality care, and encourages meaningful competition between health plans.
As Maryland considers how to build its health insurance exchange, it should keep in mind that the exchange should serve the interests of consumers—individuals and families without employer-sponsored health coverage and small businesses and their employees—not the insurance plans. Some of the people who will seek coverage through the exchange will be individuals with chronic illnesses, such as diabetes, heart disease or a substance use disorder. On their behalf, Maryland should create a robust health insurance exchange and tough requirements for participating plans, thus establishing a new market based on fair price competition and dedicated to quality improvement, and ensuring that enrollees will obtain value for their health insurance premiums.