It’s been four months since Joel Ario left HHS’s Office of Health Insurance Exchanges, a department that he headed after it was created in fall 2010. The office is part of CMS’s Center for Consumer Information and Insurance Oversight (CCIIO).
...
HEX: What do you see as the biggest barriers health insurers will face in developing and selling qualified health plans through state exchanges?
Ario: The transition to guaranteed issue in the individual market will be challenging. It is the
heart of the law and is the key to covering everyone, but it will require insurers to change their business models. In essence, they will have to compete for individual business the way they compete for [administrative services only] business in the large group market. With large employers, insurers do not identify the most costly people and put them in a separate
risk pool. They work with employers to manage costs of the overall pool…healthy and sick. Risk selection is deep in the DNA of insurers, and they are very worried about the 2O14 transition. But Massachusetts shows it can work if everyone cooperates. The bottom line is that the alternative to implementing this law is a whole lot more uncertain and there are potential downsides for insurers.
...
HEX: One of the chief complaints I hear from states and health plans is that regulations have been too slow in coming out. What are the challenges in finalizing regulations?
Ario: The core proposed rules came out last summer, but it was a long road to get to those and I’m sure it has been another long road to go from those proposed rules to the final ones. But I do think those rules need to come out this spring. They’re expected to be out in February. Carriers have told me that their drop-dead date for knowing the final regulatory landscape is June, which is 18 months out from the start date for exchange-based coverage. Plans have said that while 18 months isn’t ideal, it still gives them a manageable timeline. Defining essential health benefits was the most difficult piece of this for the federal government. And much of this responsibility has now been given to the states.
http://aishealth.com/sites/all/files/marketplace_pdf_samples/samplehex.pdf
Hat tip: AIS Health/ Inside Health Insurance Exchanges
No comments:
Post a Comment