The Health Insurance Exchange, established in the Affordable Care Act and slated to be operational in 2014, is envisioned to be an efficient and competitive marketplace where individuals and small businesses can purchase quality, affordable health insurance. The law takes a carrot and stick approach to encouraging people to purchase insurance. The carrot is the subsidies provided to help cover the cost of in premiums, co-pays and deductibles. The stick is the “individual mandate” provision of the law which requires the purchase of insurance and levies a fine for remaining uninsured.
This approach to encouraging the purchase of coverage is patterned after the very successful health reform in Massachusetts, where the rate of uninsurance has dropped to as little as 2 percent. Approximately 12 percent of people in Connecticut are currently uninsured.
Projections are that, by 2016, as many as 198,000 individuals will purchase coverage through the exchange. An estimated additional 45,000 people will receive coverage through their employers, as small businesses will also be able to purchase coverage for their employees through the Exchange.
Connecticut is working hard to develop the Exchange and is one of 12 states and the District of Columbia which have established the legal authority to set up their Exchanges. Connecticut has received $7.7 million of planning and implementation funding to-date. Exchange staff is in the process of preparing the next round of grant applications for the remainder of the money sufficient to establishing and operate the Exchange through the end of 2015, after which the Exchange must have developed a means to fund its continued operation.
So why are people standing in or outside Exchange Board meetings with Band-Aids over their mouths or leading chants about consumers needing a voice?
At the time Connecticut’s Exchange law passed in 2011 it was considered to be one of the best bills in the country. It was intended to assure that the people the Exchange is designed to serve, consumers and small businesses, were well-represented on the Board. It also included strong conflict of interest provisions to guard against the undue influence of vested interests. For example, to assure the operation of a fair, unbiased Exchange, insurance company board members and employees, are specifically prohibited from serving on the board.
In practice the appointments to the Exchange Board have not lived up to the intent of the legislation. Therefore, a legislative remedy is being sought to insure that consumers and small businesses ARE represented on the board. A bill pending before the Connecticut General Assembly, HB 5013 would add more consumer and small business members to the board as well as give a vote to the Health Care Advocate, Vicki Veltri, who is currently a non-voting member of the board.
Even if this legislation passes, new members are not likely to join the board until the May meeting at the earliest. In addition, four advisory committees were recently convened to help guide the board in some of its policy development. While these are composed of a variety of stakeholders, small business and individual consumers are barely represented.
Other aspects of the operation of the Exchange are troubling as well. An army of consultants are working with insufficient staff in place to oversee them, and little-to-no information is available to the public about what they have been hired to accomplish. The search for the CEO, a position that was initially slated to be filled in December, drags on. While meetings are open to the public and time has finally been set aside for public comment, the board often adjourns into executive session.
Connecticut’s Health Insurance Exchange has many key decisions to make in the next few months that will have a profound impact on the future customers of the Exchange. Adding consumer and small business representation to the board will be a good first step toward instilling confidence that the Exchange will serve their needs.
[Jill Zorn is the senior program officer at Universal Health Care Foundation of Connecticut.]