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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.”
Friday, December 12, 2014
BY LINDA BAKER
A conversation with Oregon state economist Josh Lehner.
Thursday, December 18, 2014
BY JASON NORRIS | OB CONTRIBUTOR
The implosion of the energy complex: The best thing for low oil prices is low oil prices.
Thursday, December 04, 2014
BY JACOB PALMER | OB DIGITAL NEWS EDITOR
Nothing says startup culture like a ping pong table in the office, lounge or lobby.
Friday, October 31, 2014
BY LINDA BAKER | OB EDITOR
Why are there so few transportation startups in Portland? The city’s leadership in bike, transit and pedestrian transportation has been well-documented. But that was then — when government and nonprofits paved the way for a new, less auto centric way of life.
Saturday, December 13, 2014
Seven tidbits of information from an agency partner and co-founder of Waggener Edstrom in Lake Oswego.
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.
Thursday, December 04, 2014
BY DEBRA RINGOLD | OP-ED CONTRIBUTOR
How important are institutional and/or program evaluations provided by third parties in selecting a college or university program?
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