Turnout High for Insurance Exchange Talks

After a series of public forums the Oregon Health Authority is left with strong public engagement but little direct mandate
The Lund Report
September 16, 2010 -- This time last year, a series of town hall meetings would have garnered far different reactions than the cordial tones state officials have encountered recently in a series of public forums around the state about healthcare reform.
The five public forums – one more tonight in Bend – focused on a specific part of the Patient Protection and Affordable Care Act: forming a state-based health insurance exchange where consumers can shop for health plans and take advantage of subsidies.
Meetings to solicit public input in Baker City, Florence and Corvallis filled the rooms to capacity, as did the 300 people who showed up in Portland on Monday evening, Sept. 13.
“We’re getting really good feedback,” said Tina Edlund, deputy director for the Oregon Health Authority, which is leading the sessions and will ultimately make a policy recommendation to the 2011 Oregon Legislature. “The conversation has been civil and smart and engaging.”
Forming a state-based health insurance exchange – what amounts to an on-line marketplace for health insurance – was mandated by Congress. But many of the details are still left up to individual states.
The Department of Health and Human Services will determine the basic benefits package that insurers must follow to participate in the exchange, but major questions have been left to state officials such as whether insurers should be allowed to sell individual and small group plans outside the exchange or whether the exchange will delve into hospital and physician charges.
At Monday’s meeting participants were asked how many health plans people should reasonably be offered.
“I think people are glad there are still decisions to be made,” Edlund said. “The federal government left us with some options so we could craft something that was very state specific.”
Board members are hearing a wide array of comments that fit the complexity of the healthcare system and the many problems that abound. Affordability is, of course, a prime concern as well as making available information based on quality. Others are urging the board to require insurers to cover alternative medicine, while some prefer a  more free-market approach.
Some, such as Ruppert Reinstadler, an insurance broker, doubt the insurance exchange will make much of a difference.
“Every agent out there has an exchange per se where you can go on-line and look at all the plan comparisons,” Reinstadler said. “So the idea that you are going to put together another bureaucracy in a time when we have so little money to spend anyway. This duplication issue drives me nuts.”
Reinstadler wisely pointed out that making health insurance affordable depends on lowering costs, which neither the federal law nor state reform efforts have sizably tackled.
“Basically everybody is paying for the same services from the same providers,” Reinstadler said. “So how can you take any cost out of that system until you get them to lower their cost.”
To participate in the process click here. http://www.oregon.gov/OHA/


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The Florence event was pleasantly impenetrable. The facilitator, despite repeatedly hearing positive expressions for single-payer, didn't discuss it -- a fact perhaps best explained when she asked what it meant - after the meeting Will an "Exchange" actually reduce costs meaningfully, particularly in the absence of a "public plan" -- which was not discussed by staff? This process, regardless of how well-intentioned, suggests another aspect of a state-wide collective suspension of reality. Regardless of a "public plan," why are we not looking to incorporate a "Maryland," or similar, provider price regulation system, which reviews costs then regulates provider prices? The Maryland hospital price regulation system has given that state outstanding results: bottom-tier uniform prices for a particular facility, good quality outcomes and good hospital financial health. rand dawson Siltcoos Lake

David, Thanks for another good article. My Linfield College "Health Care in America" students and I attended the Portland meeting. The Linfield students were impressed by the thoughtfulness of the process that allowed all sectors of Oregon to participate while listening to others who might have very different perspectives.They enjoyed meeting Dr. Goldberg and a number of local health care leaders. My students are studying how Oregon, other states, the US, and other developed countries are all trying to balance the affordability/improved health outcomes/ universal and fair access to basic health prevention and health services interconnections. They are asking to what extent insurance and administrative rules have been part of the affordability problem. They were also surprised by the reaction of one member in the audience who seemed to emotionally react to a comment about better health care outcomes in France and wondered why we are so fearful of learning about global best practices that help improve other countries health while spending much less than we do. My observation was a little different - I shared that this was the only example of disrespectful behavior during the entire evening from a crowd of 300 people on a heated topic. This contrasts markedly from some of the curious behaviors we witnessed in 2008 and 2009 from people with signs such as " Don't let the government get involved in my Medicare". I am encouraged that this more transparent and honest debate will allow all of us to better understand one another and give us the courage to do some bold things that will provide more universal access to good prevention and basic health while making health more affordable for all Oregon residents. Mike Leahy

The Portland meeting was very calm because I think most people are realizing that the OHA already has their mind made up about what they are going to do and are just going thru the process to justify the end results. The is absolutely no proof anywhere (Maryland or other) that shows that an exchange does anything but provide a few more high-paying jobs within the government sector. Oregon already has the tools in place to administer the subsudies and handle the uninsurable. Plan comparisons for individual coverage are available in dozens of places. What I find interesting is the way that the questions are written to lead participants. Do you want many choices that are really complicated or just a few plans that is very simple. No one bothered tosay that simple and many choices are not mutually exclusive. We will have the exchange - exactly like the way we got the Oregon Educators Pool, because the administration wanted it. Ruppert Reinstadler

I attended the first hour of the Portland meeting and I have to agree with Rupert. They have already made up their minds are are just going through the motions. There was no mention of a public option let alone single-payer. Feeling discouraged I left after the first hour.

An exchange, with a thorough and standardized set of information about benefits for each option, is not identical to the comparative "spreadsheets" offered by brokers, which usually contain only the most basic information. And it is not subject to influence in its inclusion of information, or its presentation, linked to different incentives like commission rates to a broker from different insurers. It also offers the consumer (or it should if regulations are appropriate) the opportunity to buy directly, decreasing the share of administrative costs that now goes to agents in most of the Oregon market, often 6-8% of the premium. Saying we already have adequate "plan comparisons for individual coverage" glosses over important differences that an exchange should bring. And our current high risk Oregon Medical Insurance Pool still leaves a number of folks uninsured, because of budget constraints and the waiting period for pre-existing and sometimes urgent conditions--not always caused by an individual's reluctance to buy insurance. We do need this new approach, with the necessary changes in financing to support universal access for those willing to pay a basic premium. Those are your and my relatives, coworkers and neighbors, all too often now.

Our broker offers much more than just a spreadsheet. The information has a list of all the providers for the various plans and everything that is and isn't covered with each plan. Almost too much information. Secondly, I am not sure about broker commissions but the anyone can buy a plan directly from the insurance provider and in my experience the price is identical as if buying through a broker. I agree with Ruppert's comments above in that I am not sure how an exchange is going to be much different that what we have now if it doesn't foster more competition and openness.