Opinion- Nebraska: Insurance Exchanges Need to Work for Rural Nebraskans

The Nebraska Legislature will soon be debating the merit of the development of a health insurance exchange in Nebraska. Rural places and their residents have unique circumstances that must be considered and addressed in the development of Exchanges. It is important to note that rural patients face the most daunting of health care challenges: they are older, poorer and sicker. Rural America is less healthy due to too much smoking, drinking and eating, and too little exercise, education, jobs and income.

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Health insurance exchanges must assure rural relevant risk sharing. We understand and support the value in the pooling of risk amongst insurers that occur amongst qualified plans for sales both inside and outside of the exchange. By pooling risk across a larger portion of the population relative to the individual market, exchanges will spread risk and create a much more stable market place. Exchanges can both reduce premium costs for residents and attract a greater volume of health plans to the market. In the past, many health plans have competed on who was best at avoiding sick people. The elimination of medical underwriting is hugely important to this principle, but it could be lost if the individual mandate and accompanying tax credits is eliminated as a consequence to adverse action by the courts.

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We realize that some have argued that national health plans are antagonistic to individual state exchanges and much prefer to compete within the context of a single set of rules determined by the Federal government as default for those states who do not establish an exchange by 2014. However, we believe that there are many high-value in-state insurance products that have developed and that these products will better continue to flourish with state-based exchanges. We believe the quality of products will increase more if exchanges facilitate a consistent set of metrics that are the focus of any incentives by health plans within the exchange.

The Nebraska Rural Health Association sees the exchanges as a critical tool for expanding access to health insurance coverage, while fostering value-based competition among private plans to promote quality and efficiency. Exchanges are particularly important in rural communities as they are in general more dependent on the individual and small group markets. To the detriment of rural communities, many have seen these markets as being less functional than the market for larger employers.


http://www.journaldemocrat.com/ag_news/x440451529/OPINION-Insurance-Exchanges-Need-to-Work-for-Rural-Nebraska
Hat tip: Syracuse Journal-Democrat