Health Care

When it comes to health care, there are few magic-bullet solutions for the many problems consumers face in the marketplace: insurers don’t compete for their business, leading to higher prices and lower quality. Important information about coverage is buried in the fine print, making it hard to know what’s really covered or which plan is right. And costs are continuing their unsustainable rise.

One of the most important elements in last year’s health care reform law is the creation of new state-based health insurance marketplaces called exchanges.  If states create a strong exchange, consumers will reap the benefits as insurers compete for their business, lowering costs and improving quality.

The earlier briefs in this series have laid out the important steps states must take to create a strong, stable exchange.  But even if the state ensures that its exchange is fair and effective, if it is not easy to use and trusted by consumers, eligible enrollees won’t materialize.

While the exchange represents a significant new opportunity for states to improve the quality and affordability of health insurance, it is only one piece of the larger health care landscape.  Public programs, including Medicaid and the Children’s Health Insurance Program (CHIP), will continue to play a significant role, and the way they interact with the exchange will be important to the success of both.

A health care exchange that pools its enrollees’ bargaining power will help give consumers a better deal on their coverage, but it will need to do more to get the unsustainable rise in health care costs under control. That is because while consumers and businesses pay plenty in premiums and out-of-pocket costs, much of our health care spending does not yield the results that we really want—healthier people.

The idea of creating health insurance purchasing pools, like those called for in the Affordable Care Act, is not a new one.  In the past, many states have experimented with creating such pools, and their experience has shown that mechanisms like the exchange can succeed at improving choice and holding down costs.  But experience has also shown that success is not automatic.