Diagnosis unknown: Will a health exchange help?

Diagnosis unknown: Will a health exchange help?

By Linda Baker

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“We want to design an exchange that is so good people are going to want to be part of it as opposed to being pushed into it,” says Aelea Christofferson, a Bend businesswoman who serves on the Oregon Health Insurance Exchange Board.
// Photo by Randy Johnson

Lurking behind every Oregon small business is a health insurance tale of hardship and woe. At Hawthorne Auto Clinic in Portland, co-owner Jim Houser pays $100,000 annually in premiums to cover his nine full-time employees and their families. That’s about double the amount he paid 10 years ago and 20% of payroll, he says. Aelea Christofferson, owner of ATL Communications in Bend, is locked into a one-size-fits-all plan that compels her older employees to pay the same deductible as her employees with small children. Jose Gonzalez, principal of Tu Casa Real Estate in Salem, has no insurance for himself or the eight agents he employs. “It’s too expensive,” he says simply.

Never-ending rate increases and lack of options are among the reasons why Christofferson, Houser and Gonzalez have high hopes for a new health-insurance program created by the passage of Senate Bill 99 this past June. Scheduled to launch on Jan. 1, 2014, the Oregon Health Insurance Exchange will be an online marketplace where individuals and employers with fewer than 50 employees can shop for health insurance while potentially qualifying for small-business tax credits and individual subsidies. The goal is to create an easy-to-navigate website where consumers can compare health plans on the basis of cost, quality and individual health needs.

“The exchange will be a trusted resource,” says Gonzalez, who, along with Christofferson, is one of three small-business representatives Gov. John Kitzhaber appointed to the 3-month-old Health Insurance Exchange Board. (Houser is a member of the Health Exchange Consumer Advisory Group.) “It will allow me to protect my family and employees.” Other small-business advocates are even more enthusiastic. “To call the exchange transformational is too little a word,” says Ryan Deckert, president of the Oregon Business Association. “It will change the whole way individuals and businesses purchase health care.”

But if anticipation is running high, the challenges — and uncertainties — ahead are significant. The board, which is crafting a business plan for the exchange, due February 2012, must also resolve a variety of complex policy issues, ranging from types of insurance plans and rates to the construction of a consumer-friendly website. At stake is more than the design of a system that will appeal to small businesses and insurance companies alike. A bigger question is whether the exchange, which is less an overhaul of a broken system than an incremental market-based reform, can actually make a dent in the affordability and accessibility of health care — especially in Oregon, which already has one of the most competitive small-group insurance markets in the country.

“The long-term goal is to leverage the purchasing power of the exchange to help improve health-care quality and outcomes, which will eventually impact cost,” says Rocky King, executive director of the Oregon Health Insurance Exchange, a public corporation. If the exchange fails to accomplish this broader task, says King, its impact will be limited. “It will be nothing more than a market aggregator.”

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