Health Insurance Exchanges the Epicenter of Health Care Reform

By HealthInsX - Aug 24, 2011

Health insurance exchanges will be the new health insurance marketplace starting 2014, thanks to the new health care reform law the Affordable Care Act. Americans will shop from the convenience of their home computer and have access to guaranteed issued, one-stop shopping for all their health insurance needs. All states have between now and January of 2014 to have these exchanges up and running, and for those states not interested in setting up and running their own exchanges the federal government will handle it for them. These new online health insurance exchanges will provide more than convenience and loads of useful consumer information but also offer competitive side by side comparison of health plans, affordability via tax credits administration and multiple standardized benefit packages with essential health benefits. Only health plans from approved insurance companies that meet the stringent new reform regulations and consumer protections will be allowed in these exchanges.

The Goals of the Health Insurance Exchange Concept

• The purpose of the Health Insurance Exchange is to make health insurance more affordable and accessible for small businesses and individuals. Here is an outline for this new marketplace created in the Affordable Care Act.
• Create State Insurance Exchanges where individuals and small businesses can compare and purchase health insurance online – among other places – at competitive prices.
• For states that choose not to operate their own Exchange, there will be a multi‐state Exchange run by the Department of Health and Human Services.
• State insurance commissioners will continue to provide oversight regarding consumer protections, rate review, and solvency of insurance companies.
• One-Stop Shopping to Promote Informative Choice, Competition and Transparency
• Health coverage options available in a zip code will be listed on state‐based web portals and elsewhere.
• Using the Internet and other means to present consumers with available plans will make purchasing health insurance easier and more understandable.
• Individuals will be able to choose coverage among several benefit packages all including an essential set of benefits that provide comprehensive health care services with different levels of cost sharing.
• To ensure competition, state Exchanges will have a national plan supervised by Office of Personnel and Management and may include state‐based nonprofit coops and multi state insurance plans.
• Requires standardized format, definitions, enrollment applications, consumer satisfaction, and marketing requirements to allow easy comparison of the prices, benefits, and performance of health plans.
• Establishes a toll‐free telephone hotline to respond to consumer requests for assistance.
• Creates online eligibility determinations with regard to health care premium tax credits or public programs, and consumers without access to the Internet will be able to enroll through the mail or in person in a variety of locations.
• Health coverage Navigators in states will conduct public education activities, distribute information about enrollment and premium credits, and provide enrollment assistance.
• Awards grants to states to establish, expand, or support health insurance consumer assistance.
• Ensure Affordable Health Insurance
• Provides premium tax credits to subsidize the amount individuals and families pay up to 400% poverty spend on health insurance premiums.
• Provides cost‐sharing credits for individuals and families up to 250% of poverty to help ensure affordable coverage.
• Sliding scale tax credits are available to small employers with fewer than 25 employees and average annual wages of less than $50,000 that purchase health insurance for employees.

The primary beneficiary of the health insurance exchange will be individuals and families for many of the above stated reasons. Also, Small Business Health Option Plans Exchanges (SHOP Exchanges) will be available to business with fewer than 100 employees providing a grand new competitive marketplace for their needs. Both consumer parties will gain additional choices, beneficial regulation, information, and convenience along with affordability via tax credit administration along. Some 32 million uninsured Americans will gain access to affordable health insurance other Americans will have superior coverage and consumer protections not to mention portability. Small business will gain better access and choices also, and if they are unable to provide their workers a group health plan their employees will have direct access to the health insurance exchange for coverage.

The Affordable Care Act Health Care Reform Improvements

Some of the new consumer protections include protection of coverage against pre-existing conditions, capping out-of-pocket expenses, eliminating annual and lifetime caps on coverage and allowing children to stay in the parents plans under extenuating circumstances till age 26. Consumers will no longer be paying premiums for inadequate coverage or be denied access to coverage due to medical history at the insurance companies’ whims or even dropped due to them. Insurance companies will be mandated to use 80 – 85% of premiums received towards health care or refund the difference to insurance consumers; this is known as the “medical loss ratio”. No wonder there is such a large political out cry of well heeled special interest trying to repeal the Affordable Care Act. As they are in the minority, their strategy seems to be to convince the impressible and uninformed public that the health care reform bill is bad and to repeal it, with misinformation gorilla tactics, leveraging mass media with their big money. Wake up Joe and Jane American! Access to affordable health insurance is your gateway to healthcare for you and your family, you know, your sons & daughters, mom and dads. Get your priorities straight, the corporate conglomerates will surely take care of theirs’ and it’s not you or your family.

Obamacare is Healthcare Reform We Should Embrace

Obamacare is the term used by its detractors; these include the corporate special interests and their champions the Republican Party. As an American patriot you would be foolish to buy into their misinformation campaign. Let me tell you why. The detractors would have you believe it's only the less fortunate 40 to 50,000,000 Americans who will gain in the Affordable Care Act but this is not the case. All Americans have a stake in healthcare reform unless you are so fortunate as to be able to provide self-insurance for your healthcare another words you're a multimillionaire and above. The majority of Americans have for decades relied on the current employers’ group health insurance unless of course you are not so fortunate to have access to a group employer's plan. The health care reform naysayers would have you believe that workers with such coverage have just splendid health insurance. And they would try to pit said American with employer coverage against those Americans less fortunate who have no insurance coverage. Their effort is to create a wedge between Americans and those with employers health insurance and those without it who will gain the most in healthcare reform as they have nowhere but up to go. Do not buy into this propaganda!

Group employer health insurance have many major flaws Americans should be aware of: if your employer doesn't offer group health insurance than the employee has no access, if your employer does offer health insurance your choices of said coverage is chosen for you by your employer as they are the owners of the health plan there is no portability with employers health insurance once employment is terminated so is your health plan. Now I don't know about you but I don't like the idea of having to rely on my employer for my health insurance or care for that matter. It seems to me that having health insurance independent from my employer allows for much more freedom, why should an employer have such leverage over an American worker. Also as a freedom loving American I would prefer to have more choices for my health insurance and healthcare than what my employer might want to provide or choose for me. But I guess if I'm stuck with a plan my employer provides that I can live with at least I will know with the Affordable Care Act if I want to leave my employer who provides my health care plan at least I will have access to a health insurance exchange to get health insurance replacement, portability will no longer be an issue and the employer will have less leverage in my life. So you see, Joe American has much to gain from the Affordable Care Act it seems at least 95% of Americans will be better served for it. By the way the status quo employer's health insurance is a government subsidize health care plan also, it's just done a little more discreetly. The employer writes the health care plan expense off its taxes as part of its' employees compensation and the employees pay no income taxes on the health plan benefits it receives a part of compensation while neither pay FICA taxes on the health insurance cost.

Let me clarify and help you understand the questions you should be asking yourself. As an employee you have only the choices of health coverage that your employer is willing to provide as the employer controls the insurance policy plan and all its offerings, from there you get to choose – some choice. Also, how do you feel about the leverage your employer gains by being the provider of access to your health insurance? If you lose your job or want to leave your job you must leave your employer's health insurance and how does that make you feel? You and your family are beholden to your employer for essential health insurance. Why in the world would Americans want their employers to have such leverage & control in their lives? Kinda makes you their beeach – don’t it? Isn’t America supposed to be the land of the free? Now consider how self-employed and employees without employer health plan offerings feel. They don’t even have it as good as you!

Here's the real kicker, the political detractors of health care reform cry it's a government takeover but the fact of the matter is Americans will gain immense personal freedom. Granted government will be infringing on corporate control in your lives but I guess this must be the detractors’ real concern. The status quo employers’ health insurance is and always has been a government sponsored program as these corporate employers are subsidized for their cost via tax write-offs. So really if you're looking for freedom, health insurance access, portability, greater choice in comprehensive health insurance and better consumer protections then the Affordable Care Act is a humongous step in the right direction. Spin is spin and facts are facts. So, when you hear the term “Obamacare” it should instill a warm fuzzy feeling from now on.

When the Affordable Care Act is fully implemented in 2014, the health insurance exchange will be the new face of health insurance. Hopefully Americans will reap many benefits that include access, affordability, portability and transparency in healthcare. I feel confident the majority of Americans will gain much more than they lose with the Affordable Care Act. One thing for sure, the health care system in America or the “status quo” has been an embarrassment, this new health care reform is a big step in the right direction. The question is: will Americans wake up and see the light before it is snuffed out by the political party of the “status quo” and special interest corporate detractors – it will come down to the 2012 national elections as detractors know that once fully implemented they will have no chance at repeal as Americans will realize the benefits of health care reform – 2014 could be a new day for healthcare in America.