From Health Economics Consulting Group
Health insurance exchange mechanisms are not without tradeoffs and by themselves are far from a perfect means to improve overall health insurance access. We identify five important legal obstacles to the optimal functioning of exchange programs, and we identify an additional nine economic issues that could potentially limit the value and effectiveness of health insurance exchange mechanisms. In terms of legal issues– even assuming states’ reforms involving risk pools, employer mandates, individual mandates, and exchanges will clear ERISA challenges– there are a number of other complicated legal issues that should be taken into consideration. These include portability and group versus non-group distinctions (i.e., Section 125, HIPAA, COBRA, and list billing) as well as the adverse selection and cost challenges posed by guaranteed issue and community rating. In addition to these complexities, there are a host of economic issues inherent to mandates and government-administered exchanges, chief among them are concerns over whether exchange mechanisms could improve access appreciably, the fairness of the programs, the costs of the programs, service quality, adaptation, and overall economic impact. Thus, given the dearth of studies of the legal and economic aspects of combinations of mandates and exchanges, it seems clear that more study should be done prior to the consideration of these policies.
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