What Must Health Insurers Offer 2.5 Million Californians?

Beginning a new phase in it’s effort to remake California’s Health Insurance marketplace, California’s Health Benefit Exchange Board began exploring new standards and requirements Health Plans must meet to compete for the roughly 2.5 million new customers likely to participate in the Exchange beginning in 2014, many of whom will be receiving financial assistance from the Affordable Care Act (ACA).

A key component of the ACA is the creation of a new competitive health insurance marketplace, called the “Exchange,” where individuals, families, and small businesses can make apples to apples comparisons of health plans based on cost, quality, network size and customer satisfaction  A major departure from  today’s dysfunctional health insurance marketplace to be sure. 

The California Health Benefits Exchange is tasked with using a competitive process to help curb costs and to set minimum requirements for participating QHPs, to “provide healthcare coverage choices that offer the optimal combination of choice, value, quality and service.”.

To that end, the Exchange Board heard a number of presentations from a range of groups on the issue of how to define a QHP.  While a number of the presentations promoted concepts to lower consumer costs, improve quality and lessen consumer confusion around obtaining affordable insurance, there were a few presentations which pointed the Exchange down a path toward needless consumer cost, confusion, as well as unnecessary and unfair burdens on patients.

Consumers Union urged the Exchange to use its core values as a guide to determining the criteria required for health plans to meet the minimum QHP standards. The criteria must work to stimulate innovative strategies for providing high-quality affordable healthcare, promote prevention and wellness, and reduce health disparities.  Furthermore the Exchange should keep consumer interest in the foreground and require plans to meet the needs of patients and their families while providing affordable coverage and access culturally appropriate care for all Californians.

The decisions the Exchange makes now are essential to its ultimate success, but more importantly to the ability of millions of currently uninsured and underinsured Californians to access quality, affordable and secure healthcare. If done correctly, QHP standards are an important ingredient in providing consumers with meaningful choices, greater control and improved quality in their healthcare.  Consumers Union will continue to monitor this issue as California works to create a new health insurance marketplace for all of California’s families and small businesses.

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