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Identifying and addressing potential barriers to essential design elements of state based Health Insurance Exchanges: Lessons from the European marketplace
Tuesday, November 18, 2014
Joel M. Lee, DrPH
,
College of Public Health, University of Georgia, Athens, GA
Su-I. Hou, DrPH, CPH, MCHES, RN
,
Health Promotion and Behavior, University of Georgia, Athens, GA
Deborah Murray, EdD
,
College of Family and Consumer Sciences, University of Georgia, Athens,, GA
Curt Harris, Ph.D.
,
College of Public Health, Health Policy and Management, University of Georgia, Athens, GA
The creation of Health Insurance Exchanges (HIEs) is mandated by the Patient Protection and Affordable Care Act. As a cornerstone of health reform legislation they serve as public marketplaces where individuals can access, compare, select, apply for and enroll in public and state approved private health insurance plans. However, HIEs are new to the traditional U.S. health insurance market, and failure to properly plan and implement certain essential design elements can result in exchanges that are not able to effectively and efficiently operate and carry out government mandated functions. HIE marketplaces have operated in many European countries for decades and study findings show that no matter the country, HIEs have certain design elements in common. These include: risk adjustment models, risk equalization related to adverse selection, the ability to offer a sufficient number of health plans to ensure competition, plan compliance for HIE participation, issues of churning based on changing individual eligibility requirements and movement between public and private plans, among others. Switzerland and the Netherlands have been identified as having HIE marketplaces similar to those implemented in the U.S. Through history and experience both have identified barriers to effective HIE design and challenges to efficient administrative operations. U.S. HIE marketplaces are in their infancy and as they mature decisions around their design, operations, and management will be evaluated and re-considered to improve efficiency and effectiveness. Understanding how HIEs have operated in the Swiss and Dutch markets and the lessons learned could inform decisions on the operation of state-based HIEs in the U.S. This presentation will describe several barriers to essential design elements identified by these two markets. It will also explore how Swiss and Dutch national and canton governments re-designed their HIEs to remove barriers, improve administrative operations, and make marketplaces attractive for participation by private insurance carriers.
Learning Areas:
Administration, management, leadership
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Learning Objectives:
Describe barriers to essential HIE design elements and the adjustments made to improve administrative efficiencies by two European HIE marketplaces
Discuss how state based HIE marketplaces can benefit from the lessons learned by the Swiss and Dutch HIE marketplaces to design more effective and administratively efficient organizations.
Keyword(s): Affordable Care Act, Health Insurance
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I serve as the public health program subject matter expert on the topic of the Affordable Care Act, have conducted health reform roundtables featuring state legislators, presented to county health officials on the challenges before local health departments in benefiting from health reform programs and activities, and researched this subject matter extensively as part of a doctoral dissertation.
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.
