Alternatives to our current over-priced and dysfunctional health insurance market are often biased, and thus limited, by our current operational and regulatory structure. These structures are so entrenched in our healthcare psyche that it makes it difficult sometimes to set these aside in our minds while entertaining how another approach might work.
If we view all alternative plans to replace the Affordable Care Act from the vantage point of “what is”, then there is little room for anything other than attempts at further regulating the problems away. If one presupposes that the current regulatory framework remains unchanged, indeed the same framework has served to suppress the very market we wish create, then of course that market will not be created.
The dilemma facing alternative healthcare plans being considered to replace the ACA is particularly evident when it comes to the issue of selling health insurance across state lines. A brief on this subject published by the American Academy of Actuaries in February of 2017 speaks to the the main challenges facing the advent of a viable interstate market for the sale of health insurance.
The Sessions – Cassidy bill:
Private exchanges have been creating a buzz in the employer-sponsored health care marketplace. After a flurry of activity in 2013 and 2014 among large employers, many feel we have moved beyond the “early adopter” stage and are poised for broader acceptance. Private exchanges are becoming more commonplace with more organizations than ever before implementing exchanges or actively considering them.
Alex Alvarado, Matthew Rae, Gary Claxton, and Larry Levitt
Kaiser Family Foundation
Separate from the ACA, so-called “private exchanges” have also started to emerge as an option for employers
providing coverage to their workers. These private exchanges do not provide access to premium subsidies like
the public exchanges, nor do they necessarily involve standardized coverage tiers. But, they do have the
potential to reshape the employer-sponsored health insurance, which covers 149 million people, or nearly 56%
of the U.S. non-elderly population. We conducted interviews with more than fifteen private health insurance
enrollment platforms, as well as several employers and health plans moving in this direction, to create a picture
of this quickly growing landscape. We identified ten of the platforms we interviewed as full private exchanges
(based on the definition described in the next section) and have profiled those in the appendix.
Many approaches are sold as “private
exchanges” since the concept is now in
vogue. In profiling these efforts, we have
sought to define what differentiates the
new, more competitive approaches
analogous to the ACA’s public exchanges
from the traditional technology platforms
that simply provide online enrollment.
Also, what we describe here as private
exchanges are targeted at employers,
which eliminates many of the “e-brokers”
selling directly to the individual market.
Characteristics that exemplify a private