Getting a head start on mandatory health care in 2006 was likely a very good initiative for the Commonwealth, especially in light of what is happening in the rest of the country since the Supreme Court upheld the provisions of the Patient Protection and Affordable Care Act (PPACA).
On May 20, an above-the-fold front page article written by Tracy Jan for the Boston Globe entitled US won’t mirror state on health details some of the challenges that most states will be facing in the coming months. Three of our takeaways are as follows:
Lobbying efforts by health insurance companies could lead to challenges for residents in most states
Since January, 2011, 44 health insurance companies have spent almost $136M on federal lobbying efforts, which has resulted in a dilution of federal oversight on the exchanges they manage. In these states, the federal government will permit any plan that meets a minimum standard to be offered.
This lack of standardization will result in confusion as consumers will be selecting coverage using an “apples to oranges” methodology. It’s a sad but sometimes true business adage, as health care consultant Wendell Potter pointed out – insurers “profit from confusion” when alluding to the complexity of plans that will be offered to the consumer under federally managed exchanges.
One year delay of the out-of pocket maximums
Initially, insurers were required to adhere to an out-of-pocket maximum of $6,350 for individuals. During the one year delay of this provision, health plans that use different managers for prescription drugs and medical care will apply the maximum to each service provided, resulting in a potential doubling of the out-of-pocket expense for many.
Present and potential future good news
34 states have opted for a federally managed health insurance exchange system. Of the 16 that did not, Massachusetts remains one of only six that require standardization in the health care options offered by the state. By using this method, insurers compete for business by allowing an “apples to apples” comparison. Jon Kingsdale, former head of the Commonwealth Health Insurance Connector Authority, who now serves as a consultant to other states who seek to develop their own exchanges added a hint of optimism: “2014 is the start line…not the finish.”
