Fixing the Health Insurance Exchanges


[GEAR WINDING] We’ve had a lot
of recent reports about the failing of the
health insurance exchanges. There are some areas
of the country where there aren’t very many
insurance companies participating in the exchange. Recently in 2017, there’s
been a substantial increase in the insurance premiums,
at least in some states. But there are things that can be
done to stabilize the exchanges and we can learn
from states that have had successful
exchanges, like California, how to repair them. The first thing is
we need to make sure that the exchanges are
attractive for insurance companies so that more
insurance companies participate. They need to actually see
more people buying insurance. So how do we get more
people into the exchanges? Well, one thing we can
do is to actually improve the marketing of the exchanges. Keep informing people that they
can actually buy insurance, they have to buy insurance
as part of the mandate, and that there are
substantial subsidies to help offset the
premium price– so marketing, especially
to the 20% of Americans who still don’t know that
they have to have insurance and that there are
good subsidies to help them buy insurance. A second answer is that we can
actually increase the subsidies to individuals, especially
slightly higher income individuals, to buy insurance. One of the things
we’ve learned is that people with slightly higher
income, like the median income, actually find insurance
on the exchange unaffordable because
their subsidies don’t help them enough. So improving the subsidies
could help people buy insurance. A third approach is that we can
help the insurance companies through reinsurance so
that they are protected against having super high
costs and expensive patients and by risk adjustment so that
an insurance company which gets good healthy people doesn’t
actually profit by doing that. They’ve helped the
insurance companies who’ve attracted sicker patients
because of their good services and we balance out
the risk pools. That would allow it
to be more financially advantageous for
insurance companies to participate in the exchanges. And finally, we
might think of ways of getting people who are
not eligible necessarily for the exchanges
into the exchanges. One thing some states have
looked at and actually done is to say that people
who should get Medicaid through the Medicaid
expansion, they’d actually get premium
support and subsidies to buy insurance
in the exchanges. This expands the
pool of people buying insurance in the exchange and
therefore makes it more stable. So these four ideas,
improving the marketing to bring in people who need
insurance but haven’t bought it, improving the subsidies
for people to buy insurance, helping the insurance companies
through reinsurance and risk adjustment, and
finally expanding the pool of people who are
eligible to buy insurance in the exchanges, are
all different ways of stabilizing the exchanges
and making them thrive. [GEAR WINDING] [WHOOSH] [GEAR WINDING] [WHOOSH]

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