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|Articles - July/August 2014|
|Friday, July 11, 2014|
Page 5 of 6
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.”
Wednesday, October 22, 2014
BY JOE ROJAS-BURKE
Bans on genetically modified crops create uncertainty for farmers.
Thursday, October 02, 2014
More than 5,500 employees from 180 organizations throughout the state participated in the 100 Best Nonprofits to Work for in Oregon project.
Thursday, November 13, 2014
BY RYAN CARSON | OP-ED CONTRIBUTOR
How do we skill up our future technology workforce in a smart way to take advantage of these high-paying jobs? The answer shouldn’t focus only on helping people get a bachelor’s degree.
Wednesday, October 22, 2014
BY AMY MILSHTEIN
Everyone knows college is expensive, but a look at the numbers brings that into sharp — and painful — focus.
Wednesday, November 26, 2014
BY NISHANT BHAJARIA | OP-ED CONTRIBUTOR
By now, anyone who knows about it has a position on President Obama’s executive order on immigration. The executive order is the outcome of failed attempts at getting a bill through the normal legislative process. Both Obama and his predecessor came close, but not close enough since the process broke down multiple times.
Friday, October 17, 2014
BY TOM COX | OB BLOGGER
How can you move from a command-and-control leadership model to one of true empowerment and accountability? David Marquet did, and he took notes along the way.
Tuesday, October 14, 2014
BY JONATHAN FROCHTZWAJG
A flare-up in the Elliott Forest raises questions about détente in Oregon’s timber wars.
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