By Linda Dailey Paulson
August 3, 2011
The US federal government has provided $241 million in grant funding in order to create technology that can be used by consumers and small businesses to purchase health insurance. The creation of these health insurance exchanges was mandated by the national health system reform law.
Initial grants were awarded in July 2010. The states receiving funding included Kansas, Maryland, New York, Oklahoma, Oregon, and Wisconsin, as well as a multi-state consortium headed by the University of Massachusetts Medical School, according to the American Medical Association. These states are charged with developing the technology that will underpin their own health insurance exchange, but the technology these grantees develop will be shared with other states.
The agency noted that it has intentionally chosen states with widely different demographics for the grants to “help ensure that a wide range of [information technology] models are developed, and every state will benefit.”
States are required to form their own health insurance exchanges by 2014. They can select one of these models to implement. If they fail to create an exchange, the U.S. Department of Health and Human Services (HHS) will intervene.
As HHS explained, these exchanges are designed to provide consumers with a means “to compare plans based on price and quality. By increasing competition between insurance companies and allowing individuals and small businesses to band together to purchase insurance, Exchanges will lower costs.”
HHS adds that the technology to be used in these exchanges will “take the often complicated process individuals and small businesses face in purchasing insurance on their own and turn it into a simple, easy to navigate experience that benefits consumers rather than insurance companies.”
The health insurance exchanges will be specifically designed to lower costs by pooling purchasers needing private insurance, offer one-stop comparative shopping for both consumers and small businesses, and may provide consumers with additional benefits such as premium tax credits and reduced cost-sharing, depending on the purchaser’s income.
The final rules for these exchanges were released in mid-July of 2011, leaving grantees relieved, but still challenged with how they would proceed with creating the insurance pools and the technology to support them.
Sandy Praeger, Kansas’s commissioner of insurance, told Bloomberg that time is now of the essence for all states. “If a state decides to establish an exchange, its officials must make significant progress by Jan. 1, 2013, and must have a fully operational exchange in place by Oct. 1, 2013, so individuals and small-business owners can begin purchasing coverage.
“Before then, many critical decisions must be made and difficult tasks completed, not the least of which is developing information technology that will enable coordination among state agencies, federal agencies and insurance carriers.
“Overall, I am pleased that the rules include the flexibility states need to establish exchanges that will be effective for their individual populations and marketplaces. What may work in Massachusetts or California is not likely to work in Kansas,” she stated.
“The ball is now in the states’ hands. Those that want to create exchanges must move quickly to design and establish systems that will best meet their objectives. I hope Kansas will accept this challenge, because if the state doesn’t, the federal government will.”
Linda Dailey Paulson is a medical and technology journalist for Providian Medical Equipment, a leading seller of refurbished GE, Sonosite, and Medison ultrasound equipment. Find out more at ProvidianMedical.com.