While the U.S. Supreme Court will not announce its decision about the constitutionality of the Patient Protection and Affordable Care Act until June, the establishment of Rhode Island’s Health Benefits Exchange moves ahead – as it should.
As a health-benefits adviser to hundreds of small-business clients across Rhode Island, I have been on the front lines of the health-insurance business for close to 20 years. My clients range in size from a small group of one to a few hundred employees, but they all want the same thing – to have insurance options that provide quality care at an affordable price – and finding products that suit their needs is my goal.
I support the establishment of the exchange and believe it could be a valuable tool for small- business owners and uninsured individuals to find the coverage they need. Unfortunately, it is easy for this opportunity to become a liability, so I want to share my thoughts about what the exchange should – and shouldn’t do.
• The exchange needs to be simple and focus its efforts on facilitating coverage for individuals and small businesses that do not currently have coverage.
• The exchange should be a complement to the current marketplace. Small businesses happy with their health insurance should be allowed to continue to purchase it as they do currently.
• The exchange should be limited to small employers as defined under the law (50-and-younger employees presently; increasing to 100 in 2017), as any expansion of the market would restrict the ability of large employers to positively impact their own rates through wellness programs and incentives.
• Finally, the existing regulatory authority – the Office of the Health Insurance Commissioner – should remain in place for products sold inside and outside of the exchange; there is no need for duplicate regulation.
While the federal government has pledged nearly $60 million to help establish Rhode Island’s Health Benefits Exchange, the exchange must be self-supporting after Jan. 1, 2015. The exchange in Massachusetts (The Connector Authority) is a $40 million entity, and I have concerns that an exchange of a similar scale here will be too expensive to survive, and will require a fee on insurance sold through the exchange or taxpayer dollars. Neither option is a good one.
• Employers, employees and individuals should have the choice of a broad range of product options to meet their health care needs. Give the broker community plenty of choice and options, and we will make it understandable to our clients. Marketplace solutions are essential to improving the quality of care and addressing the affordability of health care coverage.
• The exchange must allow insurers to develop innovative products both within and outside of the exchange to respond to the changing needs of purchasers.
• Finally, it is critical that all voices – and all Rhode Islanders – are represented in the process. While Lt. Gov. Elizabeth H. Roberts and her outstanding staff deserve praise for creating an open process and inviting input from all parties, it would be best to have legislation passed to usurp Gov. Lincoln D. Chafee’s executive order establishing the exchange.
The Rhode Island Health Benefits Exchange is an opportunity for more Rhode Islanders to have health care coverage than ever before. Let’s make sure we deliver an exchange that is reasonable, transparent and flexible enough to become the backbone of our state’s health- insurance marketplace for many years. •
Jim Borah is president of Borah Associates as well as the Rhode Island Business Health Advisors Council, which is a member of the Coalition for Affordable Health Care Choices.
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