Establishing State Exchanges that Serve People, Not Insurance Profits

Health care reform, if fully realized, will provide health insurance coverage for an additional 30 million people in America. One of the main ways this will happen is through the creation of centralized health insurance marketplaces, or “state exchanges.” If set up properly and well, people without insurance will be able to go to their state exchange and acquire quality health insurance at affordable prices. Members of the Health Rights Organizing Project (HROP) are engaged in implementation campaigns to make sure there is no “if” about how these exchanges are set up.

State governments have a lot of choices to make when developing their exchange. They get to decide how it is governed, what kind of insurance plans are sold, and who gets to participate in selling and buying insurance. While they have a long list of technical issues to decide, the fundamental choice they have to make is whether they are working on behalf of the health of families or the profits of health insurance companies.

The Alliance for a Just Society (formerly NWFCO) has developed nine principles to assist community organizations fighting for state exchanges that meet the needs of people, not insurance companies. Groups are demanding that their state create an exchange that:

  1. Is a public agency fully accountable to residents of the state in its governance and day-to-day operations
  2. Uses its negotiating power to make quality health insurance options available at a reasonable price
  3. Offers the choice of a public health insurance plan that sets a high bar for coverage by including the choice of a public health insurance plan that offers good benefits at an affordable price
  4. Includes as many people as possible so that the quality of health care improves over time while the costs for consumers decrease
  5. Streamlines the health insurance market by bringing together small businesses and individual consumers inside and outside the exchange
  6. Actively improves the quality of health care by requiring insurers to provide quality benefits and language access in coverage and care
  7. Efficiently connects all consumers to their health coverage options by guaranteeing seamless coverage for people moving between private and public coverage and by meeting strong standards for language, literacy and cultural access
  8. Reduces the paperwork burden for small businesses and other consumers
  9. Works in tandem with strong oversight of health insurance, including review of insurance rates to make sure they charge reasonable rates, stop discriminating based on preexisting conditions, dedicate reasonable portions of premium revenue to health care, and offer quality insurance products

States have the choice: stand with people or side with insurance companies. Insurance companies will undoubtedly be lobbying for exchanges that are weak on regulations and rich with opportunities for profit. Community groups need to make sure their voices are louder than the corporate lobbyists. The principles we’ve developed will help focus and guide their efforts as they fight for state health insurance exchanges that promote quality, affordable health care for all.

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