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3 Questions on CT's Health Exchange

Posted By Jonathan Noel, Tuesday, October 8, 2013

3 Questions is a segment where we will ask someone 3 questions (guess where I got the name of the title from) about a public health topic, how they go into the field, or just some random questions to fill up the space.

For the 1st ever 3 Questions segment, I am pleased to present Dr. Audrey Chapman, Professor at the UConn Health Center, Joseph M. Healey, Jr. Chair in Medical Humanities and Bioethics, and founding Director of the AAAS Program of Dialogue on Science, Ethics, and Religion. (She's also one of my professors and we just happened to talk about exchanges a couple of weeks ago).

I asked her 3 questions on Connecticut's new health insurance exchange.

1) The state health insurance exchanges are rolling out on October 1st; however we’ve already seen some states delay the role-out due to technical problems and the small business exchange has been pushed back by a year. How do those developments factor in to the participation rate of the exchanges and how do they affect the population’s trust that the exchanges will actually work?

I think the unexpected level of interest, which is far greater than Massachusetts experienced in the early days of its exchange, along with the inadequacy of the software to handle so many people, accounts for the problems with the roll out. It is more likely to engender frustration than distrust of the AC A. If the technical problems with the ACA can be resolved soon, they are unlikely to have a long or even medium term impact, especially since surveys show that the more people find out about the ACA, the greater their support.

It is hard to predict the impact of delaying the small business exchange by a year. I don’t think it has much impact on people looking for private insurance coverage. Given the need of many small businesses to have options for reasonably priced health insurance for their employees, it is likely there will be an uptake a year from now.

2) Other countries are currently using health insurance exchanges but there are national requirements that all individuals must purchase health insurance in those exchanges. The exchanges in the U.S. don’t have that requirement. How do you see that affecting their ability to keep health insurance premiums affordable?

Like the US, many other developed countries require that their citizens have health insurance. I think that requirement matters more than where the insurance is purchased. What is more significant is that other countries, like Switzerland and the Netherlands, which use exchange mechanisms for the purchase of insurance, regulate the content of the basic health insurance policies offered more stringently to assure uniformity with the basic insurance policy offered. Also some countries, for example the Netherlands, require that basic health insurance policies be offered on a not-for-profit basis so as to be able to hold down the cost.

3) What is your realistic expectations for the affect of Connecticut’s insurance exchange on access to quality healthcare in the state?

The low cost and subsidized insurance policies for the poor offered through Connecticut’s insurance exchange, combined with the state’s decision to adopt the ACA supported expansion of Medicaid access to citizens and legal residents below 133% of the federal poverty level, will increase access to healthcare in Connecticut. However, the quality and affordability of healthcare will also depend on other components of the ACA. Also many analysts have pointed to a potential problem of an insufficient number of primary healthcare providers to be able to care for the newly insured populations. Unfortunately the ACA will not cover undocumented residents and documented residents in the U.S. less than five years, nor provide access to insurance offered through the exchanges. Approximately 12 % of Connecticut’s population is foreign born, of which about half have become citizens. So about six percent of Connecticut’s population will not be eligible for health insurance through the Connecticut exchange.

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