Demystifying Georgia’s Plans for Health Insurance Exchange

Healthcare consumers have been hearing a lot about 2014 lately, especially with regard to what their health insurance options will be. Most know that in just over 12 months, a big change is coming to the health insurance landscape, but I’m willing to bet that the majority of that “most” doesn’t yet have a firm grasp of what a health insurance exchange is, what it will look like in Georgia, and how it will benefit their pocket books.

As an average healthcare consumer, here is my brief attempt to demystify this term, and to break down its implications for Georgia citizens.

What is a Health Insurance Exchange?
According to Kaiser Health News, a health insurance exchange (also referred to via the HIX acronym) is a state-specific marketplace/website “where individuals and small businesses can shop for coverage, which will take effect on Jan. 1, 2014, and also find out whether they are eligible for federal subsidies or for Medicaid.”

States can choose to either set up and run their own exchanges, adopt one developed and initially run by the federal government (in effect partnering with them in subsequent years), or default to whatever exchange the federal government develops. There are of course pros and cons to each situation.

States that set up and run their own exchanges will have to foot the bill for necessary healthcare information technology, call centers, customer service employees and benefits employees, to name a few. But, they are likely to (hopefully) offer plans specific to the financial and medical needs of their citizens. States that default to a federal exchange obviously won’t incur any of the above costs, but will not have any control over what health plans are offered.

What are Georgia’s Plans?
Georgia Governor Nathan Deal has stated that Georgia will not set up its own health insurance exchange, and will instead default to the federal offering. In a statement last month, Deal said, “Restrictions on what the exchanges can and can’t offer render meaningless the suggestion that Georgia could tailor an exchange that best fits the unique needs of its population.”

Georgia is certainly not alone in its decision – nearly half the states have opted to let the federal government build an exchange for them. Eighteen are going it alone, and six have decided to take the path of partnership.

Where Does That Leave Georgia’s Healthcare Consumers?
Georgians will be able to utilize a federal health insurance exchange to shop for best-fit policies. According to a recent Healthcare IT News report, the federal exchange will include “an initial application, plan evaluation tools and consumer support such as a website with chat capability and 24-hour call center through which to compare plans, check eligibility for affordability programs and to enroll in a qualified health plan.” Those qualified health plans may begin submitting applications to join the federal exchange next April.

Details of the federal exchange are still being worked out, so we can’t know for sure what health plans will be offered, what price ceilings (or floors) will look like, or how attainable/affordable any of these insurance policies will be to those that really need them. And it should be noted that consumers could always opt to pay a tax penalty, rather than purchase federally mandated health insurance.

My hope is that this type of marketplace will make healthcare more affordable, but I have a sneaking suspicion (buoyed by the opinions of several colleagues that work in health insurance) that this will not be the case. I fear that those who need insurance the most will become frustrated by the process – long hold times; lack of local, face-to-face resources; or perhaps the effects of the haze of bureaucracy that often overshadows federal programs.

2 comments Add your comment

Luke Samia

June 22nd, 2013
12:49 am

High Risk Insurance Pools – Some states can decline health insurance applications if you have a pre-existing medical condition. However, many states offer health plans that are similar to the coverage in comprehensive individual health insurance plans. ;”-.

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Moshe Mandi

June 22nd, 2013
12:59 am

health insurance is very important because it gives us a level of security during times of need.’:^-

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