Online Program

"it's all about HIM": Health insurance marketplaces on the eve of full implementation of the affordable care act and the conditions for their success

Monday, November 4, 2013 : 8:30 a.m. - 8:50 a.m.

William P. Brandon, PhD, MPH, CPH, Department of Political Science and Public Administration, University of North Carolina Charlotte, Charlotte, NC
Keith Carnes, PhD, MHA, Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC
Central to the success of the Affordable Care Act is the innovative mechanism that is designed to provide access to commercial insurance and federal subsidies for individuals in families with incomes that make them ineligible for Medicaid and who lack employment-sponsored insurance, Medicare or other coverage. Following a review of the Health Insurance Marketplace (HIM, previously called “health insurance exchanges”) in the Affordable Care Act and relevant regulations, the paper canvasses the wide range of potential activities, roles and powers that HIM might assume in providing a digital venue for individuals and small businesses to purchase health insurance. Examples include solicitation of purchaser enrollment (ranging from passive to active), insurance carrier recruitment and qualification (“any willing seller,” vetting, restrictive recruiting), regulation of insurance carrier advertising (passive, lax, active), premium oversight (rate filing, review, regulation, premium aggregation), controlling insurance policy variation (none to very restricted) within the wide federal parameters, oversight of insurance carrier provider selection and reimbursement (none, minor, significant), and ACA-mandated selection bias adjustment (lax to severe). The analysis will then isolate those HIM functions that are critical for success. Preliminary results show that the most important conditions are the ability to communicate with the relevant publics, to commodify insurance purchasing decisions, and to force robust competition among participating insurers to restrain price increases. Finally, the conceptual framework is applied to available data to assess the likelihood that specific HIMs will succeed.

Learning Areas:

Administration, management, leadership
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Provision of health care to the public
Public health or related public policy
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Define how health insurance will function under different HIM configurations; Identify conditions for HIM success; Design a conceptual framework for assessing variation among the states in HIM desing;

Keyword(s): Health Insurance, Health Reform

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: For over 30 years I have taught and researched issues of health policy. Recently, I have delivered conference papers & published a peer-reviewed article in JHCPU on the Affordable Care Act. I was an RWJ Faculty Fellow in Health Care Finance at the Johns Hopkins Medical Institutions in 1985-86. I have written extensively on issues of health care financing and on planning, including a piece in New England Journal on tax expenditures for health insurandce.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3035.0: Health care reform