Searching for a Cure

| Print |  Email
Articles - July/August 2014
Friday, July 11, 2014

ACA “Natives”

health-bonder 
Dawn Bonder, CEO of Health Republic 

Health care reform is about more than collaboration and prevention. New organizational models are also part of the shifting landscape. For example, as a compromise alternative to the hotly debated “public option” — a proposed government-operated insurer that would have competed with private companies — the ACA created a new, nonprofit type of insurance carrier called a CO-OP, a Consumer-Oriented and Operated Plan. These new entities were intended to improve competition in the insurance market — especially in local markets where just a few carriers dominate. As nonprofits, CO-OPs’ surpluses must be used for purposes such as lowering premiums or improving benefits; as “consumer-operated” plans, at least half of their board members must be policyholders.

Oregon is the only state with two CO-OPs: Health Republic and Oregon’s Health CO-OP. That puts these organizations in the unique situation of competing directly with each other. “Head to head,” says Health Republic CEO Dawn Bonder, a straight-talking ex-attorney who served as senior advisor on health information technology to former Gov. Ted Kulongoski.

The reality, however, is that the CO-OPs’ greatest threat comes from entrenched market players. The new entrants were supposed to get a boost in visibility by being presented alongside established carriers on the insurance exchanges. But in Oregon and elsewhere, of course, those exchanges never functioned as intended. “It’s been very difficult,” Prows says. “Our intention was that most of our enrollment would come through the exchange, and it didn’t.”

As Cover Oregon’s failings became evident, the CO-OPs pivoted toward more outreach to insurance brokers. Many agents, though, were leery of the newcomers. “It took a while for brokers to feel comfortable with this out-of-nowhere health plan,” Bonder says.

Cover Oregon’s failure notwithstanding, Health Republic and Oregon’s Health CO-OP fared decently in the 2013-14 enrollment period: The former enrolled more than 5,000 members, while the latter expects to hit the 5,000 mark by year’s end. Of course, compared with Moda, the 800-pound gorilla of the Oregon insurance industry, both CO-OPs are small fry. The regional insurer, with revenues of more than $2 billion, boasts more than 414,000 medical-plan members in Oregon.

Still, Bonder and Prows contend their organizations have structural advantages over traditional carriers. CO-OPs are legally required to reinvest surpluses in their organizations; in addition to touting their member-driven governance structures, both chief executives take potshots at Moda for spending premiums on building up big reserves or buying the naming rights to the Moda Center. 

“We have a very consumer-focused mission,” Prows says. “It is not to build huge reserves. It is not to rebrand sports centers. It is only to build care the way people want it.” Moda spokesperson Jonathan Nicholas responds: “None of the money spent on partnership endeavors with the Portland Trail Blazers has any impact on Moda’s insurance rates in Oregon.”

Perhaps the biggest competitive advantage for CO-OPs is the fact that the insurers are indigenous to health care reform; they have, as it were, no preexisting conditions. “Trying to move a brand-new startup organization isn’t easy,” Bonder observes, “but it’s a lot more feasible than trying to move a behemoth.”



 

More Articles

6 key things to know about summer baseball in Oregon

The Latest
Friday, June 05, 2015
basedthumbBY JACOB PALMER | DIGITAL NEWS EDITOR

As temperatures in Oregon creep into the 90s this weekend, Oregonians' thoughts are turning to — summer baseball.


Read more...

Wildcards

Guest Blog
Tuesday, July 28, 2015
China A SharesBY JASON NORRIS, CFA | OB GUEST BLOGGER

Uncertainty in Greece and China, along with potential interest rate hikes mean investors are looking at the market and nervously questioning where they should be invested.


Read more...

10 Innovators in Rural Health

July/August 2015
Monday, July 13, 2015
BY AMY MILSHTEIN | PHOTOS BY JASON E. KAPLAN

Telemedicine, new partnerships and real estate diversification make health care more accessible in rural Oregon.


Read more...

Staffing Challenge

July/August 2015
Monday, July 13, 2015
BY KIM MOORE

A conversation with Greg Lambert, president of Mid Oregon Personnel Services.


Read more...

Department of Self-Promotion

Linda Baker
Wednesday, June 17, 2015

061715-awards1Oregon Business wins journalism awards.


Read more...

Loose Talk

July/August 2015
Friday, July 10, 2015
BY AMY MILSHTEIN

When gossip crosses the line.


Read more...

Fixing Oregon’s broken roads

The Latest
Tuesday, June 09, 2015
RUCCostComparison rev4-30BY KIM MOORE | RESEARCH EDITOR

The technology at the center of Oregon’s road usage fee reform.


Read more...
Oregon Business magazinetitle-sponsored-links-02
SPONSORED LINKS