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The Nation's Health Reform Beta Site

Michael Miller, director of strategic policy, Community Catalyst, predicts that the rest of the country may soon face some of the same controversies over health insurance that have been unfolding in the Bay State:

All along Massachusetts has played an outsized role in the national health care reform debate. Chalk it up to the bipartisan nature and popularity of reform here, its success at reducing the number of uninsured, and the prominent role of Massachusetts pols in the national reform saga.

Although the national media spotlight has moved on, the work of health care reform is only beginning. As a health reform “beta site,” three recent developments in Massachusetts suggest what the rest of the country can expect as federal officials and other states begin to implement the national law.

The first is the insurance premium rate hikes controversy. After the Massachusetts Division of Insurance denied dozens of premium rate increases as being excessive, insurers sued and went on a brief insurance “strike,” pulling their plans off the market. Though a court refused a preliminary injunction and required plans to return to their 2009 rates, including two hold-outs last week, there’s no guarantee about the final outcome.

The takeaway? Insurers will play hardball to resist downward pressure on premiums, and states need strong tools and political will to fight back.

An effort to beef up premium oversight had to be stripped from the final national health reform bill because it did not fit within the rules of the budget reconciliation process, but Sen. Diane Feinstein has brought a stand-alone rate regulation bill, which was heard last week. Passage remains uncertain, though, as Republicans will likely maintain a unified opposition, and in the absence of federal authority, advocates may want to turn their attention to strengthening state oversight.

A second story with national implications to hit the Bay State wires recently is that of the alleged “short-stayers.” Insurers allege that there is a group of people taking advantage of continuous open enrollment to purchase non-group insurance for a short period of time, schedule costly medical care, and then drop out. Like so much of national reform, this claim comes with a heavy dose of politics attached, since the charges are being made by a former insurance industry exec who’s running for governor.

Insurers have yet to substantiate these allegations: They’ve not provided data which shows what medical care alleged short-stayers are using, whether or where they were previously insured, and whether the problem is growing or actually diminishing. The Division of Insurance is studying the issue and its report is expected soon.

Meanwhile, we can and should expect insurers elsewhere to fight to undermine the impact of guaranteed issue by narrowing access to insurance. The first stage of this battle will be federal, as Health & Human Services determines the initial and subsequent enrollment periods, and consumers should be prepared to push back to make sure insurance remains as accessible as possible.

The third implementation issue in Massachusetts with implications for other states is one that’s received no media attention (and was not heeded by federal lawmakers during the debate): When it comes to helping people make informed choices among competing insurance plans, standardizing actuarial values is simply not enough.

Within any given benefit tier (gold, silver, etc.), insurers can vary cost-sharing arrangements so much that comparison remains difficult. Focus groups in Massachusetts support national research findings: What people want is better choices, not an infinite number of choices. And so after several years of experimenting with actuarial value, the Massachusetts Connector has moved to standardize benefits. Federal law does not require states to create standard benefits, but it does not prohibit it, either, and there’s no reason that standardization has to wait for the exchanges to kick in 2014.

For more about national reform and how it plays out in the states, read the Health Policy Hub.

This program aired on April 28, 2010. The audio for this program is not available.

Rachel Zimmerman Twitter Health Reporter
Rachel Zimmerman previously reported on health and the intersection of health and business for Bostonomix.

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