Industry experts say although it seems early for states to establish insurance exchanges, they shouldn't risk waiting too long.
NATIONAL REPORTS-Industry experts say although it seems early for states to establish insurance exchanges, they shouldn't risk waiting too long.
State exchanges must have adequate infrastructure by January 2013. If not, the federal government will implement the exchange on behalf of the state by default. Simply not acting in time decides that the federal government will operate a state's exchange.
Samuel C. Gibbs, senior vice president of eHealth, Inc.-parent company of eHealthInsurance, an online private exchange-says that the real issue is time. Twenty-seven states have moved to block exchange participation as they wait for court rulings on the health reform law, and yet some departments of insurance are still starting the process.
In fact, most states are taking advantage of the federal government's funding, and all but two took the $1 million in funding grants.
"When broken down into smaller, individual components, the reality is that vendors with working versions of exchanges already exist in the marketplace," Gibbs says.
In order for some uniformity in the health plans offered to individuals, federal government oversight and regulation will define the exchange products. It's this wholesale change of the marketplace that complicates things for carriers.
According to Gibbs, it's likely that the new marketplace will allow opportunities for carriers to offer certain products in private exchanges along with a variety of plans in state exchanges.
"The law is flexible enough that even though the states mandate certain benefits, it's really a minimum level," says Gibbs. "So carriers have some flexibility in designing those plans."
Upended: Can PBM Transparency Succeed?
March 6th 2024Simmering tensions in the pharmacy benefit management (PBM) industry have turned into fault lines. The PBMs challenging the "big three" have formed a trade association. Purchaser coalitions want change. The head of the industry's trade group says inherent marketplace friction has spilled over into political friction.
Read More
In this episode of the "Meet the Board" podcast series, Briana Contreras, Managed Healthcare Executive editor, speaks with Ateev Mehrotra, a member of the MHE editorial advisory board and a professor of healthcare policy and medicine at Harvard Medical School. Mehtrotra is also a hospitalist at the Beth Israel Deaconess Medical Center in Boston. In the discussion, Contreras gets to know Mehrotra more on a personal level and picks his brain on some of his research interests including telehealth, alternative payment models and price transparency.
Listen
Inflation Reduction Act: Reforms to Patient Cost-Sharing
September 18th 2023Lower out-of-pocket costs for patients might put upward pressure on drug prices, as manufacturers face less price sensitivity, note Matthew Majewski and Rhett Johnson of Charles River Associates. But they also note that upward pressure on price is likely to be limited to the inflation rate as any additional price increase would need to be paid back to CMS in the form of inflation rebates.
Read More
Spending climbed by 2.7% in 2021. In 2020, it soared by 10.3%, fueled by federal government spending in response to the pandemic. The blizzard of calculations of 2021 healthcare spending by CMS’ actuaries also provides further evidence that utilization of healthcare services bounced back in 2021.
Read More