Developing a Health Insurance Exchange that Works for Consumers: Policy Priorities
DEVELOPING A MIHEALTH MARKETPLACE THAT WORKS FOR CONSUMERS
Michigan Consumers for Healthcare (MCH) actively advocates for consumer-focused implementation of the Affordable Care Act (ACA). The ACA requires the development of a health insurance marketplace which will provide access to tax credit subsidies and quality coverage that is affordable, accessible, transparent and responsive to consumers who purchase/enroll in health care coverage. SB 693 provides for the establishment of the MiHealth Marketplace to serve as Michigan’s health insurance exchange.
MCH urges the Legislature to include strategies for maximizing consumer choice and value and providing strong consumer protections that reflect the following principals:
· The exchange is to act on behalf of consumers, keeping their needs at the forefront and facilitating decision making about health insurance choices. The exchange is the service organization for the consumers.
· The exchange must have the authority to engage in those activities that assure consumers have access to affordable, high quality health insurance options. This includes the authority to hold insurers accountable and take corrective action as necessary.
· The exchange needs comprehensive certification and rating processes for health plans to ensure compliance with ACA and state requirements and the plans sold on the exchange provide good value, high quality and are in the best interests of the consumers.
· Enabling state legislation must establish a robust conflict of interest policy for voting members of the governing board.
· Enabling legislation should provide broad implementation authority that is not so detailed that it prohibits or slows down implementation with a requirement for legislative approval.
· The governing board needs independent authority to ensure the functions specified by the ACA and enabling legislation are carried out with transparency and integrity.
MCH strongly supports the following language in the current draft enabling legislation relating to the MIHealth Marketplace Board, and will oppose any effort to remove or weaken such language:
· “Members shall not currently or within the immediate proceeding 12-month period of time be employed by a carrier, producer, health care provider, or third party administrator or by an affliate or subsidiary of the carrier, producer, health care provider or third party administrator or be otherwise engaged by an entity that receives more that 50% of its revenues from a carrier, producer health care provider or third party administrator.”
· “The Board is created to govern the MIHealth Marketplace and support the health care consumers, including employers, and a majority of the voting members shall represent the interest of those health care consumers.”
MCH recommends the Legislature remove the following language from SB 693 enabling legislation which does not represent the best interest of the healthcare consumer:
· “The Marketplace shall not, with respect to establishment of premium rates, negotiate rates, require competitive bidding, or engage in other purchaser-related rates or competitive bidding.” (This language added into Section 211(1a) ties the hands of the new Marketplace in prohibiting the board from competitive bidding or purchaser-related activities. SB 693 was originally neutral on this issue and, MCH believes, should remain neutral. We may well want to let the market to stabilize before entertaining any competitive bidding or purchaser-related innovations, but it is still important that MiHealth have flexibility in determining how best to achieve their mission as events evolve. There may be instances when additional certification criteria or limiting the number of products sold on the Marketplace may be beneficial, or when piloting new delivery systems and reimbursement strategies could both benefit consumers and reduce costs. MiHealth may wish, for example, to deny bad actors a place on the exchange if they don’t offer a good deal to consumers.)
· “The Marketplace Board shall contract with the Office of Finance and Insurance Regulation to certify health plans.” (MCH is concerned that certification authority for healthplans within the Marketplace is effectively being transferred to the Office of Financial and Insurance Regulation, rather than remain with the MiHealth governing board. Final authority for all Marketplace decisions, we believe, should ultimately lie with the MiHealth board and is required under the ACA. On this matter, the Affordable Care Act reads, The Exchange must have “the capacity and authority to take all actions necessary to meet Federal standards, including the discretion to determine whether health plans offered through the Exchange are in the interests of qualified individuals and qualified employers.”)
We invite your comments and recommendations regarding these issues.