Q: What challenges do you anticipate your particular state running into with upcoming health care reform provisions?
TM:
- Insurers leaving the child-only market: In response to the requirement that insurers no longer deny coverage to children, many insurers announced they would no longer sell child-only policies, fearing adverse selection in the absence of a requirement for children to have insurance coverage. To entice insurers to stay in the child-only market, the federal government announced that insurers could limit enrollment of children to open enrollment periods. We established uniform open enrollment periods in Oregon when people can seek insurance for children. We are now educating the public about these new timelines. Oregon is fortunate that it still has options year-round for most children.
- Confusion about health insurance rate increases: Consumers are facing misleading information about the extent to which new reforms are driving health insurance rate increases. This simply makes it all the more difficult to help consumers understand the real issues underlying rate increases – the cost and use of medical care. To help educate consumers about what is driving health insurance rates and the impact of federal reform, we explain our rate decisions and post a decision summary for each rate filing on our website that includes information about how much of an increase is attributed to health reform. And, we have instructed insurers to provide us with copies of any communications they send out explaining rate increases to ensure accuracy of the communications.
- Potential adverse selection: In 2014, the law requires that nearly everyone have health insurance coverage. However, the penalties for those who do not purchase health insurance may not be significant enough to prevent adverse selection. People may simply wait until they get sick to purchase insurance coverage, which drives up the costs for everyone.
- Keeping our consumer advocates educated: We face the ongoing challenge of keeping our consumer advocates educated about the nuances of the new law and how they apply in varying situations. This includes helping consumers understand whether they have a grandfathered or non-grandfathered plan, and what changes apply to them.
Q: For producers licensed to sell health insurance in your state, what developments might they look out for?
TM: Producers should look out for the development of an exchange and the role it outlines for them. In Oregon, this is the responsibility of the Oregon Health Authority, a relatively new agency charged with implementing state health reform. An exchange proposal will be presented to the 2011 Oregon Legislature.
Q: What should producers concentrate on the most over the next 10 years with regard to health care reform's affects in Oregon?
TM: Other than the exchange, producers should keep up with insurance costs and coverage so that they can help consumers find the best fit for their family. Health reform will create an array of new opportunities for consumers – through federal high risk pools, future subsidies and tax credits, and so on. Understanding how reforms apply to small businesses and the individual insurance market will be key to effectively helping consumers.
