The Health Care Blog: Last Chance to Fix the Exchanges

By BILL KRAMER

We all know that well-designed health insurance exchanges are a critical element for good health reform, right? And we also hear that exchanges are part of all five reform bills in Congress, so we should be satisfied, right? Wrong. There are some good design elements in the various bills, but the best components from each need to be pulled together as the bills are merged, amended, and worked over in conference.

Health insurance exchanges are arguably the key to successful reform, but most of the recent health reform debate has focused on other issues – subsidies for low-income people, the penalty for noncompliance with the individual mandate, taxes on high cost insurance plans, cost containment measures, protections against high out-of-pocket expenses, etc. Many of the other elements can be tweaked if we don’t get them quite right in the first version of reform, but it’s critical to establish the right design framework for exchanges at the beginning.
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