Law360 Speaks to Joel Ario on Health Insurance Exchange Models

Law360 Speaks to Joel Ario on Health Insurance Exchange Models

"States Mull Gatekeeper Role for Health Plan Exchanges"
Law360

January 31, 2013 - Law360 turned to Manatt's Joel Ario, a managing director with Manatt Health Solutions, for insight into two models states can choose from when building a health insurance exchange: the clearinghouse model or active purchaser model.

Law360 reports that states building their own health insurance exchanges can choose how selective their exchanges will be when it comes to qualified health plans. They can choose to have a "clearinghouse" exchange, where all plans that meet the ACA's process and quality standards are offered, or they can narrow the choices by becoming an "active purchaser" on the exchange. The latter model could work in a number of ways, such as creating a standard plan for each premium-based tier on the exchange and requiring that insurers offer the standard as an option, which is what New York is planning to do.

Industry experts told the publication that several states were initially enthusiastic about the active purchaser possibilities, but as the deadline for exchanges looms, some have pulled back.

"States started to think, 'Gee, just getting the exchange up and making it a good consumer experience and integrating it with Medicaid, those things were tall orders for the first year.' So some of the talk of active purchasing has moved into the background," said Ario, former director of the federal Office of Health Insurance Exchanges.

Eventually, experts say, the trend will likely shift toward the active purchaser model if exchanges are able to attract more clients and build greater leverage.

"While the clearinghouse approach would seem to be the winner in the short run, I think the active purchaser model will likely grow in importance over time," Ario said. While it might be a bit early for exchanges to act aggressively, one that's been running for five years will have some leverage to exercise over the industry, he said.

Read the article here.

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