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MR. CHRISTENSON: What do we mean when we say “health insurance exchange?” MR. MUNSON-REGALA: A health insurance exchange is a facilitated marketplace where purchasers and sellers conduct transactions that connect folks with insurance coverage. It’s a place to shop for insurance products and public health programs like Medicaid in order to access insurance subsidies or tax credits. It provides consumers with information such as the quality, value, and cost of plans, whether or not they ever choose to purchase from the exchange. It is a place where the cost of connecting people to coverage gets reduced.
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About the Roundtable Minnesota Physician Publishing’s 38th Minnesota Health Care Roundtable examined the topic of accountable care organizations. Six panelists and our moderator met on Nov. 1, 2012, to discuss this issue. The next roundtable, on April 25, will explore the subject of patient engagement.
MS. MCMULLEN: Anyone employed by a large employer who is self-insured will not be eligible to purchase through an exchange.
MS. MCMULLEN: From the business perspective, the most important part of what an exchange can and should be is a place for consumers to have the ability to compare different products and enroll in them. DR. SAWYER: It’s a potential stepping-stone toward improving access to care because more consumers will be able to more effectively shop in a sophisticated electronic marketplace. We need to remember that insuring more people does not necessarily lead to universal access. It does not necessarily remove obstacles to receiving care. Will it be a good step forward? Potentially, yes, depending how it’s implemented and how the public receives it. DR. DEHNEL: Everyone wants more health care for a broader segment of the population at a better cost. It’s important to make a distinction between health, which is something we all want, and health care, which is something paid for by health insurance. You can have the world’s greatest health with very few health care services; likewise, you can have the world’s greatest health insurance without necessarily having access to health care services. In talking about the exchange, focusing on insurance is only part of the discussion. Access to care, that’s part of a broader discussion. MR. CHRISTENSON: What do we hope to accomplish with health care exchanges? MR. MAYNARD: To insure the uninsured. An exchange should be a one-stop shop for determining eligibility into government programs like Medicaid and CHIP (Children’s Health Insurance Program), alongside commercial products that can be funded partially
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thousand will be small employers and their employees, defined as groups of 50 or less. Some of those groups could change, dependent on policy decisions made next session. For example, should we expand “small employer” to include groups of 100 or less? Fundamentally, an insurance exchange is intended to serve individuals and small employers.
Health insurance exchanges Assuring they are meaningful through subsidies. The complexity of this is the complexity of all the different programs, plan designs, and products that have to be brought together to accomplish this. MR. SCHUYLER: An exchange will increase transparency around cost and quality, especially in comparing benefits. You’re comparing plans based on price, but in an exchange, you’ll also be able to compare plans and carriers by quality based on different metrics. Increased transparency will be valuable to consumers. MR. CHRISTENSON: Who will be eligible for coverage in health care exchanges? MR. MUNSON-REGALA: A study on the Department of Commerce website projects enrollment in a health insurance exchange to be 1.2 million Minnesotans. Of those, 700,000 are expected to be in Medicaid based on the assumption we’re going to expand Medicaid. We’ll see in the next legislative session if that assumption is accurate. Three hundred thousand individuals are expected to purchase health insurance products, potentially with the assistance of an advance premium tax credit. Two hundred
MINNESOTA HEALTH CARE NEWS FEBRUARY 2013
DR. SAWYER: Every two years, the Minnesota Department of Health publishes a report on insurance coverage. I think the last one reported over 500,000 uninsured Minnesotans. That’s larger than the population of St. Paul, and it’s been increasing steadily over the past several years. More shocking is that of those 500,000 uninsured, 70,000 are children. That’s double the enrollment of the entire Minneapolis school district. Those people often get care in the most expensive clinics we have—hospital emergency departments. Costs are being incurred, yet access to care is a challenge for these people because they lack affordable coverage. And these numbers don’t include people who have high-deductible insurance plans. They have coverage, but it’s not of much practical value to them. MR. CHRISTENSON: What important elements must be included in the health insurance exchange if the benefits that we’ve been speaking of are to be realized? DR. DEHNEL: First, make insurance more understandable to everyone by providing consumers with a much better understanding of what health insurance can and cannot do for them. Second, make it as transparent as possible. We want to make sure those choices lead to decisions that are as well informed as possible for people participating in the exchanges. MR. MAYNARD: A critical aspect for it to be successful is to have choice. To have choice, participation of the plans, employers, and consumers is critical. MS. MCMULLEN: I agree, a variety of options for consumers is important, as is ease of navigation. People assume that this may be like Travelocity, and you’re going to be able to go online and easily buy your ticket for health insurance like you do for travel. Insurance is