In the continued political conflict over health reform – now centered on whether states will set up their own insurance markets, to be known as exchanges – it is easy to lose focus on whether health reform is actually working. We have, however, some very interesting early indications on that score. Some are positive, others are negative. Neither, though, fit easily into the talking points of either side in the political debate.
Today the California Assembly Health Committee will hold a hearing on a bill that would allow state regulators to reject health insurance rate increases deemed excessive or discriminatory. This hearing will come just six days after the first board meeting of the California Health Benefit Exchange. Many hope that the Exchange will take the lead in holding insurance rate increases down through actively negotiating with insurers. Can active negotiation work in tandem with rate regulation?
Federal health reform will add as many as two million more people to California’s seven million person Medi-Cal program. What will it take to guarantee this expansion exists not only on paper but results in meaningful access to quality healthcare for new enrollees? The first thing to understand is that this may require a substantial commitment of state resources.
The news has been full of stories in recent weeks of how Anthem Blue Cross has been trying to increase health insurance premiums by as much as 39 percent for some people who buy insurance on their own, outside of the kind of group coverage a person gets from an employer. Almost entirely unnoticed, meanwhile, has been a more newsworthy development: in a time when medical costs have been rising rapidly, premiums for many public sector workers enrolled in a Blue Shield of California HMO have actually gone down.