The Case For the Exchanges

The Federal government will push forward to establish health insurance exchanges regardless of how the Supreme Court rules on the Affordable Care Act in the weeks to come, argues THCB contributor Maggie Mahar.  The only sensible conclusion?  The states should accept Washington’s help and open up the market for insurance online.

The Affordable Care Act (ACA) calls on the states to create health insurance exchanges – marketplaces where individuals and small businesses can shop for and compare health insurance plans. Beginning in 2014, insurers peddling policies on an exchange will have to meet the ACA’s standards by covering “essential benefits,” capping out-of-pocket expenses for individuals, and offering more transparent information about costs and benefits.

Best of all, insurers will not be able to turn down customers suffering from chronic diseases, or charge them higher premiums.

So far so good.

But some states are attempting to derail “Obamacare.” Florida, Louisiana and Alaska have openly declared that they will have nothing to do with setting up exchanges. Last week, Politico.com reported that many others are stalling. The post quoted one consultant predicting that “between five and 10 states” will meet the 2014 deadline. The American Prospect confirmed the news, adding that some states that had begun making plans “have slowed down while awaiting the Supreme Court ruling on the health law.”

Tea Partiers celebrate such reports as a sign that health care reform is toast. Better-informed conservatives understand that even if states don’t create exchanges, the federal government will come in and do it for them. The law is very clear on this point.

This is why John Goodman, editor of the conservative Health Policy Blog, is urging states to move forward to design their own health insurance markets. In principle, there is nothing wrong with a health insurance exchange,” he writes, as long as it is set up right. In order to retain as much control as possible, Goodman advises states to “engage in preemptive reform over the next two years”

The Supreme Court

Some in the chattering classes have suggested that the Supremes may toss out the entire law, including the exchanges, when they strike down the controversial mandate which requires that Americans buy insurance or pay a penalty. The legal question turns on whether mandate can be “severed” from the rest of the legislation, Washington and Lee law professor Timothy Jost explained in a phone conversation last week.

During oral arguments before the Court, two – perhaps three – of the Justices seemed taken with the idea that the mandate is “the heart of the law.” If this metaphor were true, and the mandate were eliminated, the ACA would be a corpse. But on a panel of nine, two who believe in metaphors do not constitute a majority.

As health policy veteran Linda Bergthold indicates in this Health Insurance Resource Center post, it is most likely that the body of the law will remain intact.  The court might overturn the mandate, but she writes “there are a number of ways to get around” that decision and forge ahead with reform.

Reform is a process, not an event

Still, it’s true that many states have been dragging their feet. How will they set up exchanges from scratch by 2014?

They won’t. They will have help.

First, health reform will be a process, not an event. The government made this point in a May 16 “draft blueprint” for the exchanges: “The process of establishing an exchange may extend beyond the first date of operation and may include improvements and enhancements to key functions over a … period of time.” The states will continue to receive grants throughout 2014, and they will have three additional years to spend the money.

During that time, the blueprint explains, the Department of Health and Human Services is willing to partner with them. Most likely, HHS will design enrollment, process applications for subsidies, and staff the call centers that will field the bulk of consumers’ questions.

“There is some efficiency to one entity” setting up Exchange IT, observes the Center on Budget and Policy Priorities’ Judy Solomon. There is no need for each state to reinvent the wheel.

“We have to be realistic;” the process “will be bumpy,” Solomon added in a phone interview last week. But “over the next couple of years … the political situation may change.”

Indeed, a J.D. Power & Associates study released in March reveals that voters already are becoming more aware of the exchanges – and the majority want the opportunities they will offer. Ultimately, Solomon suggests, even the most intransigent politicians will discover that “their residents want the coverage available in neighboring states.”

Maggie Mahar is an author and financial journalist who has written extensively about the American health care system. Her book, Money-Driven Medicine: The Real Reason Health Care Costs So Much, was the inspiration for the documentary, Money Driven Medicine. She is a prolific blogger, writing most recently for TIME’s Moneyland. Previously she wrote and edited the Health Beat blog for the progressive think tank, The Century Foundation. Previous work for the Health Insurance Resource Center includes Health reform: a huge victory for womenShe also provides background on Congressional health care legislation for HealthReformVotes.org, a special project of the Health Insurance Resource Center. This post first appeared at http://www.healthinsurance.org/

42 replies »

  1. Insurance companies wil be able to cover anyone with a pre-existing
    condition because a great many more young, healthy people will be
    joining the pool. Their premiums will help pay for the care that sick people need.
    Today, the majority of twenty-something and thirty-something who don’t have insurance don’t buy it becuase they cannot afford it. High-income
    young peope have insurance, middle-income and low-income people don’t. (The notion that young people don’t buy insurance because they think they’re invincible is a myth. Research shows that the cost is the barrier.)

    Under reform, they wil be eligibe for pretty generous subsidies, and so will be more likely to sign up.

    Young women are espeically likely to buy insurance because under reform, contraception and various preventive services that women need will be free (no co-pays.) Maternity will also be covered in all policies.
    And insurers will no longer be able to discriminate against women.
    Today, in most states, women pay 30% more than a man of the same age for a policy that doesn’t even cover maternity.

    People who are too wealthy to be eligibe for a subsidy (a family of 4 with
    joint income over $88,000) may wind up paying more for insurance if what they have today is a “bare bones” policy with many holes. But the
    vast majority of families in that income bracket have employer-based insurance and will keep what they have.

    Insurers agreed to cover pre-existing conditions without charging more because they understand how reform will bring more young, healthy people into the pool.

  2. I don’t understand how health insurance companies can stay in business accepting anyone regardless of pre-existing conditions without raising their premiums. All they will be doing is paying out claim after claim. Also most Americans do not fully understand health insurance, that’s why they turn to licensed agents to help them answer any questions they might have. I can see this being a huge mess.

  3. Because the government introduces a huge tax bias to having employer based health “benefits” in lieu of money wages. If I went to my employer and asked for a raise to compensate for dropping health benefits it would not happen.

    I have heard anecdotes that many self-identified “uninsured” cash-paying patients are actually insured. However, for medical care below the deductible they do not want to waste time and energy dealing with managing a claim and just present themselves as uninsured, with cash in hand.

  4. Bob–

    Yes, I realize that in other countries , the government regulates/negotiates the prices that providers charge.

    Unfortunately, U.S. doctors and hospitals — and their lobbyists– would never let Congress pass legislation to woudl let government regulate. (They won’t even let Medicare negotiate with drugmakers–though I think eventually that will happen) .Lobbyists and politicians representing doctors and hospitals would tell the American public that if government regulates prices, our heatlhcare would quickly deteriorate.

    Even Medicare has a very hard time adjusting rates downward on just one service. Though under the ACA the Secretary of HHS will have the ability to lower rates for “overvaluled sersvices” and raise rates for
    “undervallued services”
    I believe that she will do both, and I’m quite certain that she doesn’t have to go through Congress. O
    One of the things I like about the ACA
    is that in various ways, it lets HHS and CMS do an end-run around
    Congress– which means an end-run around the lobbyists.
    It’s interesting to recognize that legislators themselves wrote all of the sentences in the bill that begin “The Secretary of HHS may . ..”
    They pruposefully tied their own hands so that they wouldn’t have to make some unpopular decisons– or publicly resist lobbyists about these decisions. I’ve compared them to Achiles lashing himself to the mast so that he won’t be seduced by the Sirens.
    Finally, our proviiders set prices because when insurance first started in this country, that’s what Blue Cross/Blue Shield did. It let them set
    “Usual and customary fees.”
    Then when Johnson passesd Medicare, he was told that he would have to do the same– or it would never get past the lobbyists/Congress.
    Johnson thought this would be okay– he knew that many new speicalists would be coming into the marketplace, and assumed that this would create competition that would lower doctors’s fees.
    He was, of course, wrong. In health care, compeitioin doesn’t work the way it does in other markets. When there are more sellers (hospitals and doctrors) in a marketplace, prices don’t go down.
    After 1965 (Medicare) doctors’ and hospital’s price went straight up.

  5. Maggie, you mentioned that future insurance premiums will depend on what future prices are charged by doctors and hospitals.

    This may be true but it does not have to be this way. In other nations, and under Medicare and Medicaid, regulators and insurers actually set the prices.

    If a hospital charges $5,000 a night and the Medicare fee schedule lists the ‘DRG’ at $2,000 a night, the patient is not forced to pay the extra $3,000.
    Medicare is not forced to pay the additional $3,000. (I am using approximate numbers.)

    In other words there are limits on balance billing.

    The insurance world under age 65 has no legal limits on balance billing.
    The providers can raise prices all they want, and as you implied, insurers have to keep up with them to varying degrees.

    What we need are balance billing rules, which say, in effect, that if an insurer pays $1,000 then the provider must accept that amount, or perhaps 110% of that amount……assuming that the insurer’s payment is reasonable by national standards.

    (I once reviewed a college health plan which paid $25 for anesthesiology during an operation….that was not reasonable.)

    This will help keep insurance premiums from rising quite so fast. Providers will hate it, (in fact in Canada there was a doctor’s strike over this very issue in the 1960’s.)

    But in truth, the aggressive providers have brought this on themselves.

  6. “The fact is, if the government freed us to spend our own money on our own health care, prices would drop…”

    What’s stopping you from spending your own money? Drop your insurance, if you have any, and go ahead and negotiate on your own.

  7. “Without health insurance people don’t have access to health care.” That obviously incorrect statement may be the root cause of this country’s health crisis. It’s as absurd as saying that without car insurance people don’t have access to a car.

    On May 27, the Los Angeles Times reported on hospitals giving significant discounts to cash-paying patients, debunking the notion that insurers somehow add value by negotiating network discounts.

    The fact is, if the government freed us to spend our own money on our own health care, prices would drop, and most of us would go nine years out of ten without having to process a claim through an insurer, because we’d only pay premiums for catastrophic coverage.

  8. Tiffany–

    Sorry– meant to reply to you in my last comment.

    You are right: the entire ACA should be embraced.

    It is made up of many moving parts, all of which hang together.

    The net result will be insurance for millions–and better care at a lower cost. Many people don’t realize how the ACA will lower the cost of care,
    while lifting quality. Like God iIt’s all in the details, and most people don’t have the time to read pages of deatils.

    Unfrotunately, the media hasn’t done a very good job of laying out the details one by one, in digestible form.

    Too many pundits are more interested in the politics of health care reform (which are sexier) than the nuts and bolts of the legislation.

  9. Bot Hartz & Tiffany

    Bob — I think you and I would agree that heatlh insuarnce and life insurance are two very different animals.

    Health insurance is a necessity. Without it, people don’t have access to heatlh care. And we all need heath care; at some point in our lives, most of us will need quite a bit of heatlh care. .

    Life insurance is good protection if a working motther or father dies unexpectedly, and the family was depending on their income to help pay the mortgage, for college, etc. But in most cases, the parent doesn’t die early,, so while that protection can be valuable, it isn’t a necessity..

    Life insurance also helps poorer people pay for funerals. But again, this isn’t a necessity. Today, fewer people are having elaborate wakes, burials with expensive caskets, expensive cemetary plots, etc.

    Health insurance is a necessity, which is why we need a mandate– everyone in the pool–which will greatly lower premiums.

    Research shows that younger people don’t buy health insurancve, not because they think they’re “invinciible” but because they really cannot afford it. The subsidies will bring the vast majority into the pool, lowering premiums so that lower middle-class and middle-cass 20-sometings and 30.somethings can afford insurance (This is why the CBO says that if the mandate is struck down, premiums will be far higher.)

  10. Hynotherapy & SS

    Hypnotherapy — Thank you!

    SS: The good news is that, under reform, you will have to pay nothing out of pocket for preventive care– which includes most of the care that healthy people use.

  11. Peter I–

    On why prices will be different for different policies, see my reply to Dr.

    Let me add that some insurers will be able to offer lower premiums because they will be better at keeping a large population heatlhy.,
    For instance, today, Kaiser has greatly reduced mortalities among
    patients suffering from heart disease, and has done a good job of using prevenentive medicine to keep its patients healthier. This reduces Kaiser’s costs.

    But today, Kaiser’s premiums are not noticeably lower than competing insueres’ pollicies (though the coverage is often better, accoding to customers’ ratings ) because iKaiser is competing with insuers who are offering coverage that donsn’t cover nearly as much preventive care–or charges higher co-pays for that care.

    The problem is that most customers are not able to read all of the fine print detail in their policies to make good comparison of what one policy versus another offers in terms of bang for the buck. They don’t realize that they would get more value from the Kaiser policy ..

    But under reform, Kaiser will be competing with other insuers on a level palying field. They will all have to offer essential beneifts. None will be able to put limits on much they will pay out over the course of a year, or over the course of a lifetime. In other words, they all will have to cover that child who sufers from cancer for nine years. And some of those children will survive (Today, those kids can be cut off by the insurer after it has laid out a certain amount. of money)

    Because insuers will be on a level playing field in terms of what they must offer, customers will be in a better position to compare poliicies. And in the Exchanges, they will be able to contact navigators (people who help them make comparisons) at no cost. The navigators wll not be paid by insurance companies, and will have no vested interest in any policies.


  12. DR. MIke, everyone–

    Please ignore the last three lines in my last post. Somehow, my reply closed and printed before I had a chance to delete them.

  13. Jonathan H., Dr. Mike,

    Jonathan:: According to the dictionary “peddling” just means moving from place to place to sell something. (The term goes back to pushcart
    peddlers. ) The dictionary notes that in recent years, “peddling” has become associated wtih “peddling drugs” (a 3rd defintition, but I understand why you felt a negative connoatition..

    I used the term mainly because I wasa trained as a financial journalist, and learend to find synonymns for words like “buy” “sell” and “pay.” Otherwise, our stories wouldl use those words in every other sentence.
    So, financial jouranlists often use slangy terms like “lay out” for “pay”or ‘peddling” for “sell”.

    Colin– Because if you read the ACA, and the Mass Law in detail, you will find that they are very similar. .

    Surprsiingly, Mitt Romney oversaw “Obamacare” in Mass and it has worked out quite well. (Far from perfect. But many more people have
    healthcare, and are satisfied with the results of the law.).
    And the things that the fear-mongers said would happen never

    Dr, Mike —

    You are right that “all the plans on the exchange will have to meet the same basic coverage requirements”.

    You ask: “if those requirements are in fact fairly comprehensive, won’t those polices be fairly expensive? ”

    Yes, comprehensive policies will be more expensive than some of the “Wwiss cheese policies” that some insurers now sell– policiies filled with rricky holes that buyers dont’ realize are there,–until they become sick, and fall through the holes (For instance, you find that yoru surgery is covered, but not the rehab that is necessary after that surgery. Or “maternity” is covered–but nott complications during pregnancy, or complications during delivery.

    What is important to note is that these “comprehensive policiies” will be les expensive than they are now becuase many more people will be in the pool payinfg for them–including young, healthy people who might like the protection but can’t afford them now. Under reform, they will have subsidies that allow them to join the pool, lowering the cost of comprehssive insurance (without holes) for all of us.

    Finally, all of the policies will not be the same. Some will offer MORE than the essentail benefits, and many upper-middle class Americans will
    buy them (just as some seniors now buy the most expensive MediGap policies)

    Moreover, some polilcies will have higher deductibles and co-pays and lower premiums. Healthy, realtively afflluent individuals may prefer them, feeling that they don’t go to the docxtor that often, and don’t expect to be
    hospitalized. At the same time, they will have the protection of comprehensive insurance if their medical luck turns.

    Finally, regarding your second comment: YOU DO HAVE A CHOICE: You Don’t Have to Buy Insurance. You Can Pay the Penalty–Which Is Quite Low.

    Then, if you get sick, and want insurance, you will still be allowed back into the system. The penalty is designed to cover the “free-rdiers who decide to stay out of the system until they need it. This is eminently fair, though if there are too many “free riders” we may have to raise the penalties.

    Finally, we don’t know what the premiums will be because we don’t know what doctors, drugmakers, hospitals etc. will be charging in 2014. They
    can raise their prices at any time– and over the past 10 years, their prices have been going up. Recently (in the last 2 years) hospitals have not been lliftning their prices as much., But it’s impossible to precdict what will happen over the next year or so.

    We also don’t know how many young & healthy people will decide to pay the penalty rather than buy insurance. That also will have a huge effect on premiums: if more healthy people are in the pool,, premiums will be much lower.

    You also

    And if they are fairly expensive, will there really be any policies available that exceed the “basic” coverage? Would anyone buy them

  14. I have sold and administered life insurance for many years, and what we find is that guaranteed-issue life policies cost two or three times what an underwritten policy costs.

    Not saying that this will hold for health insurance, I don’t know. But if it does, that will mean a need for more costly subsidies. And that too is all right, but the group that is to receive subsidies is not a solid voting bloc — and so there will be a temptation to chip away the subsidies for other budget causes.

  15. I think these exchanges are a good thing, and I don’t understand why states are fighting it. They can’t possibly want the federal government to step in. They should look at Vermont, they are taking a pro acitive role in creating their exchange. The exchanges are going to benefit everyone and lower our premiums because as individuals we will have more options and insurance companies are going to have to treat us better if they want our buisness.
    I have been in the work force for over 10 years now and have been paying premiums. I hardly ever have to use my insurance but when I do, I have to pay a lot out of pocket. I’m hoping this will change.

  16. I don’t understand how supporters of these insurance exchanges expect the premiums to be very far apart. After all they’re measuring risk and the risk is the same if they have to offer the same policy to the same people and the insurers are saying their profit margins are small.

    “Best of all, insurers will not be able to turn down customers suffering from chronic diseases, or charge them higher premiums.”

    No, but they will price the policy higher for everyone unless the government subsidizes the risk. I can’t wait though for the supreme court to strike down the mandate. Then the line, “why should I buy insurance, I don’t need it yet.” will really come true.

  17. Thanks, I didn’t know about the 4 levels. I actually like the idea of the exchanges, I am just disappointed that there is not more understanding of how people at different income levels actually need (or at least would benefit from) insurance products that simply do not exist today, and that will not exist due to the required “range of services.” If you are not going to get a subsidy, why would you, if you had a choice (which you don’t), pay premiums to the insurer so that they could pay your doctor visits? What a stupid idea we have all come to accept. I need a high deductible for surgery/hospitilization/ER, about a $1250 deductible for radiology services, about a $250 deductible for lab, and currently have no need of prescription drug coverage nor do I desire to pre-pay for my preventive services or doctor visits. I have to believe there are a lot of people who would like to see the numbers on what the premiums for such a plan would be. I had heard that there might be some HSA type products in the exchanges, but have also heard ACA weakens HSAs. I have also heard that ACA might allow for some direct pay plans (Qliance?) but haven’t seen reports of any plans to include such. 60% – 70% – 80% – 90% is nice and all, but it is still a percent of the exact same thing, and I don’t think that one size fits all.

  18. Dr. Mike, all the plans won’t be exactly the same. Kaiser has a good information sheet called “What the Actuarial Values in the Affordable Care Act Mean” you can see at

    From that pub: “The ACA identifies a range of services that must be included in the benefits package that all individual and small business plans must use – and requires preventive services to be covered with no patient cost-sharing… HHS). These requirements apply to all tiers of health insurance coverage, meaning that differences in the levels of coverage will reflect variation in cost-sharing, not differences in the underlying benefits…
    “The ACA specifies that beginning in 2014 insurance newly sold to individuals and small businesses in an Exchange or otherwise must be at one of four actuarial value levels: 60% (a bronze plan), 70% (a sliver plan), 80% (a gold plan), and 90% (a platinum plan)…”

    So not all plans will be exactly the same. Plus, it’s easy to see how insurers can try to differentiate their plans: by offering extras, such as vision or dental. Or offering 24 hour call centers with nurses. Or having a network that guarantees appointments within 24 hours, etc.

    The Exchange serves the purpose of allowing easy comparison. While plans may offer a basic benefits package, nothing says the price has to be the same. One would think easy comparisons of prices and services would be a good thing for consumers.

  19. I’m sorry, but I don’t get it – can someone explain it to me?
    If all the plans on the exchange have to meet the same basic coverage requirements, and if those requirements are in fact fairly comprehensive, won’t those polices be fairly expensive? And if they are fairly expensive, will there really be any policies available that exceed the “basic” coverage? Would anyone buy them?
    So…Won’t all the policies on the exchange essentially be the same with little to distinguish one from another? If so, why is the exchange necessary again? Why not just pick an insurer, call them directly and ask for their “PPACA plan”? The mechanics of the exchange would seem to serve no purpose.

  20. Whenever an advocate of individual choice in health care advocates state exchanges as a way to pre-empt or limit the harm inflicted by Obamacare, supporters of government-controlled health care immediately applaud. This should make the dwindling number of free-market exchange advocates should realize that they are kicking the ball towards their own net.

  21. I don’t know, maybe if a sizeable portion of citizens realized they really had power, by perhaps not paying their taxes and employers who also had some intestinal fortitude followed suit, what, government is going to jail millions of citizens, oh no, they’ll just fine us and then when the fines aren’t paid then jail those masses at that point.

    But, we are gutless as a society, and the monarchs we call representatives know this. Hence how this garbage legislation came to be in the first place.

    The U.S.A., the Useless State of Americans!

  22. I would like to back out of the mandate for funding the Defense Department. What are my odds of succeeding?

  23. Seems like it depends on how you use it. Googled peddling and the second choice was “influence peddling”: “The practice of using one’s influence with persons in authority to obtain favors or preferential treatment for another, usually in return for payment.”

    seems very applicable here depending on how you interpret PPACA’s intent.

  24. why is it people so easily accept the application of mandates? You can ignore the question at the top of the thread, but, it really speaks volumes for those who just think they can apply a concept universally to every single person in a situation and refuse to accept exceptions from the overall population. That is why mandates are inherently not good applications in the end. We are a country of individuality.

    Oh, I forgot, unless you are already inside or have contacts with the group creating the mandate and inherently will create exceptions, just no let anyone know or minimize the reasons for allowing it, then the question has no validity.

    It is amazing how there are still 1200 exceptions to the mandate as I have read the applicants’ intents. Not reading much in this person’s posts about that, do we? What is she really peddling?

  25. I guess my only question is, without the mandate why would we think the state exchanges layed out by the law are going to look more like Mass than Utah?

  26. There are financial incentives in terms premium subsidies for those who qualify to use the Mass Connector. The Utah Exchange is focused on the small group market and has no incentives for anyone to use it. Since insurance brokers control the small group market in most states the low uptake in Utah is not surprising. I am sure the vast majority of brokers are steering businesses away from the Utah Exchange because they rightly see it as a threat to their business.

  27. Similarly, margins decline as commodification increases. Remarkable how few people consistently understand and apply that point in public policy. (Marketers and strategists for companies that want to increase their margins apply it constantly, of course.)

  28. Maggie, what’s with “peddling” here? You’ve used it twice now. It’s a gratuitous cheap shot that doesn’t advance your argument but does piss people off who are persuadable.

  29. Colin, why look at Utah and not Massachusetts? MA was the model for the exchanges in federal health care reform. Utah is the “lite” version favored by the political Right. And yes, Utah’s has been pretty much empty of participants.

  30. Colin–

    Utah’s Exchange came into being before all of the laws that will be implemented in 2014 kicked in.

    . That’s the big difference.

    Beginning in 2014 , any insurer selling in the Exchanges will not be able to
    discriminate against people suffering from preexisting condtions: insurers will have to cover them and cannot charge them more.

    Insurers peddling policies in the Exchanges also will not be able
    to charge women more. (Right now they charge women an average of 30% more for policies that don’t even cover materntiy) .

    In addition, because insurers selling in the Exchanges will have to cover Essential Benefits, they won’t be able to charge copays and deductibles for preventable care, and won’t be able to cap payments over the course of a lifetime, or over the course of a year. All of this will make it much, much easier for consumers to compare policies in the Exchanges. They just won’t be able to vary by that much.

  31. Margin is inversely correlated with transparency. The inconvenient sidebar truth of “Free Markets 101.”

  32. Speaking as the president of a small corporation (we just went over 50 as I have hired 8 people in the last year), it is very difficult to compare insurance policies. I am a physician, I have been buying these policies for years and it is still difficult to follow them and accurately compare. I think I am on pretty good terms with my broker, I took care of his wife twice during deliveries, but he still does not always help to clarify differences. The insurance companies, IMHO, go to great lengths to make it difficult to compare policies. I would love to have an exchange option.


  33. Not like the exchange has done much for, say, the state of Utah. Not a lot of tangible changes since it launched 2009. Is anyone still using it?

    Besides the essential benefits (which will be a disaster without the mandate), what makes the federal exchange or the ones dictated to the states different than previously tried exchanges, like Utah’s?

  34. Charlene,Steve,, Brian

    Charlene : If you read a one-page summary of the Affordable Care ACt you will find out that it will be much easier to compare insurance policies because they Will have to meet “uniform criteria.”

    They will all have to cover the same esssential benefits.
    They will all have to cover preventive care without co-pays or deductibles.
    They will all have to cover people with pre-existing conditions without
    charging them more.
    None will be be able to cap how much they pay out in a given year or over the course of a lifetime.

    The Exchanges wil also employ “navigators” to help people make the comparisons.

    Steve– Yes, Exactly.

    Brian– Brokers and agents are paid by insurance companies. Too often they are paid to promote a particular policy (that is lucrative for the company) —
    even if it isn’t the best policy for the individual.

    In the Exchanges, people answering customers’ questions will not be
    paid by insurance companies. They will receive no bonsues for pushing certain products. They will have no vested interest in doing anything except
    trying to steer people to the policy that best meets their needs.

    And no, brokers and agents were never free. Insurance companies paid them, and then passed the cost along in the form of higher premiums.
    What they paid brokers and agents were part of their “administrative

  35. how is the boon doggle bail out any different than the services that a competent and licensed Broker has offered for DECADES ? *at no cost to the government?!?!? (free market advocates – already had this widget; welcome to the show)

  36. The PCA and Ryan plan require exchanges, IIRC. They are just a means to publicly and transparently list and compare different insurance plans. It is something which market advocates should support.


  37. The fallacy in the concept of exchanges for health insurance is that the detailes of each plan and their costs are laden with pages of gibberish, meaningfully incomprehensible to most Americans.

    They might work if there were uniform criteria specified with which to compare.

    The fine print is always a gotcha.

    Finally, the reliance on EHR and CPOE is intrinsically flawed as a way of reducing the costs of care. If anything, they increase the costs because of the massive amount of time wasted by the health care professionals, and the errors that cause serious neglect and injury to patients.