Page 20 - 2013-mar-apr

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h ea l t h i n s uranc e e xchang e s
20
MAR / APR 2013
I 
Healthcare Journal of NEW ORLEANS  
the inability to continue to offer premium
discounts to young males between 20-40,
is likely to discourage many of them from
purchasing insurance. This relatively
healthy segment has, in the past, helped
subsidize older, sicker segments, so insur-
ers worry that might drive up premiums
will be 10-15% more expensive than mem-
bers who are currently insured.
Despite the challenges, Bertaut says
Blue Cross & Blue Shield is on board
and has been crafting its plans for the
exchanges for about two years. “We have
about 75% of the information we need to
be effective on a federal exchange, but
there are some key things they haven’t told
us yet,” he said. Since health plans across
the country needed more information and
were concerned about rapidly approach-
ing deadlines, a group of them got together
and made recommendations to CMS/
CCIIO on a number of issues that were
critical to Exchanges. “The Feds have been
amenable to about 90% of it,” said Bertaut.
“Frankly I think they were grateful for the
help, because the departments responsible
for setting up Exchanges are pretty over-
whelmed. The deadlines are very, very
tight.”
What about providers?
“It’s way too early to know how it will affect
providers,” said Louisiana State Medical
Society spokesperson Sadie Wilks. She
indicated that providers were watching the
developments, but weren’t willing to weigh
in just yet. On the surface, exchanges would
seem to be beneficial to providers because
if more individuals are insured, the amount
of uncompensated care that is delivered
should go down, explained Meyer. How-
ever, that is only beneficial if the providers
receive adequate reimbursement from the
insurers. If insurers are struggling to keep
premiums down to remain competitive in
the exchanges, it is conceivable that there
may be increased issues when negotiating
reimbursement with hospitals and other
providers.
Since people with insurance are more
likely to seek medical care, there is also
an anticipated increase in patient loads
which could place an additional stress on
an existing shortage of primary care phy-
sicians. In addition, if the state reverses its
position and opts for Medicaid expansion,
The rules have changed in a
rather incremental fashion
over the years. But when
PPACA passed, wewent from
increments to changing the
game pretty drastically and
quickly.
The federal government
is regulating a lot of areas they
never touched before.
–Mike Bertaut, Louisiana Exchange Coordinator, BCBSLA
for everyone. “I wouldn’t be surprised if a
lot of young and healthy folks stayed unin-
sured next year and just paid the $95 fine
or 1% of income,” said Bertaut. “If it goes up
in later years, they may reconsider; at least
if you buy insurance you are getting some-
thing for that money.” Under PPACA, insur-
ers may not charge higher premiums based
on gender or health status, but can charge
higher premiums for older members and
for those who smoke.
In an attempt to offset the unknown risk
of the new restrictions placed on insur-
ers—whether they will have enough healthy
insured to offset the ones who are not—
insurers must pay an annual fee, based on
market share into a central fund. If they take
a huge loss, some of it may be mitigated by
that fund. However, if exchanges don’t work
well and they all take a loss, that pool could
become depleted pretty quickly. According
to Bertaut, losses are definitely anticipated.
Nationally, actuaries expect that those pur-
chasing insurance through the exchanges
which would fetch a significant premium
in today’s market. There are concerns by
Greenstein and others that requiring this
“kitchen sink” approach to every plan
offered will force premiums higher than
people will be willing or able to pay. Also,
according to Blue Cross and Blue Shield,