Is health care affordable?With all of the excitement and confusion over the Affordable Care Act (ACA), one of the most important components  of the law is the establishment of Health Insurance Exchanges.  So what exactly is an Exchange?

An Exchange is either a non-profit or a government agency that will offer health plan choices and answer consumers’ questions about coverage options, premiums, deductibles and assist with coverage appeals.  The Exchanges are put in place to protect patients from over-priced premiums and prevent discrimination based on health risks or pre-existing conditions.  In Massachusetts, Exchanges are called Connectors.

All states have the option to either set up their own Exchanges or let the federal government establish the state’s Exchange.    The ACA funds the establishment of Exchanges to the tune of $30 million.  So, even if governors balk at the idea or say they won’t participate, they have probably already started planning how Exchanges will operate in their areas.

Exchanges will initially serve businesses with fewer than 100 employees and people who have to buy their own insurance like the unemployed, self-employed and retired individuals who are not eligible for Medicare.  The idea behind bringing these groups of people together is the premise that pooling large numbers of individuals into one group will reduce premiums and increase options.  Exchanges will provide people with the bargaining power currently only available to large corporations and unions.  In theory, ordinary people will get lower premiums and higher quality coverge by participating in an Exchange.  I will address the aspect of expanding Medicaid in a separate blog.

The Exchanges will offer health plan choices and serve as a place where consumers can get their health insurance questions answered.  They will also certify insurance plans and monitor the offerings for fairness and affordability.  While all Exchanges will be required to have call centers, walk-in facilities aren’t mandatory. Also, multiple Exchanges will not be allowed to serve the same geopgraphic area.

Senator Jay Rockefeller has created a public plan for Washington state that may serve as an example of what will come.

 

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