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Health Insurance Exchanges: House or Senate Style?

Friday, January 08, 2010

Health insurance exchanges can potentially serve a variety of policy ends, from promoting transparency and competition among health plans, to pooling or reallocating risk and administering subsidies for those unable to afford health insurance premiums. Exchanges can also play a role in health insurance oversight. Many of these functions are being carried out by the Massachusetts Connector, the exchange set up by that state’s reform law.

Both House and Senate reform bills include an exchange, but the proposals differ in several important aspects. This briefing, cosponsored by the Alliance and The Commonwealth Fund, considered those differences.

One major difference is that the House proposal would set up a national exchange, with states having the right to opt out; the Senate version envisions state exchanges. What are the strengths and weaknesses of each approach? How do the respective bills address the issue of risk adjustment? What powers does each grant to the exchanges in order to control premium costs? Who is allowed to participate in the exchanges?

These questions and more were considered by the panelists: Tim Jost from Washington and Lee University Law School; Jon Kingsdale, head of the Massachusetts Connector Authority; and Philip Vogel of the Connecticut Business and Industry Association. A new paper was available at the briefing (and now online below), written by Professor Jost and funded by The Commonwealth Fund, comparing the treatment of exchanges in the two bills. Sara Collins of Commonwealth and Ed Howard of the Alliance moderated.


 Ed Howard, Alliance for Health Reform, Moderator
 Sara Collins, The Commonwealth Fund, Moderator
 Timothy Jost, Washington and Lee School of Law, Speaker
 Jon Kingsdale, Massachusetts Connector Authority, Speaker
 Philip Vogel, Connecticut Business and Industry Association, Speaker
(Click on the camera icon to see a video of the speaker's presentation.)

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Transcript (Word Document), 1/21/2010
Full Webcast/Podcast: Health Insurance Exchanges: House or Senate Style?

The full webcast and podcast for this briefing, as well as videos of individual speakers' presentations, are provided by Kaiser Family Foundation.

Speaker Presentations

Timothy Jost Presentation (PowerPoint), 1/8/2010
Jon Kingsdale Presentation (PowerPoint), 1/8/2010
Philip Vogel Presentation (PowerPoint), 1/8/2010
Sara Collins Presentation (PowerPoint), 1/7/2010

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Agenda (Word Document), Alliance for Health Reform, 1/7/2010
Source List (Word Document), Alliance for Health Reform, 1/7/2010
Speaker Biographies (Word Document), Alliance for Health Reform, 1/7/2010
Making Exchanges Work in Health-Care Reform (Adobe Acrobat PDF), Committee for Economic Development, 12/14/2009
Starting on the Path to a High Performance Health System: Analysis of Health System Reform Provisions of Reform Bills in the House of Representatives and Senate (Adobe Acrobat PDF), The Commonwealth Fund, 1/7/2010
The Comprehensive Congressional Health Reform Bills of 2009: A look at Health Insurance Delivery System, and Financing Provisions (Adobe Acrobat PDF), The Commonwealth Fund, 1/7/2010
The Health Insurance Provision of the 2009 Congressional Health Reform Bills: Implications for Coverage, Affordability and Cost (Adobe Acrobat PDF), The Commonwealth Fund, 1/7/2010
Federal Health Centers (Adobe Acrobat PDF), Congressional Research Service, 4/1/2014
Health Centers and the Uninsured: Improving Access to Care and Health Outcomes (Adobe Acrobat PDF), National Association of Community Health Centers, 5/1/2014
America’s Health Centers (Adobe Acrobat PDF), National Association of Community Health Centers, 3/1/2014

Offsite Materials (briefing documents saved on other websites)

A Fix for the Utah Health Exchange, The Salt Lake Tribune, 12/21/2009
Health Insurance Exchanges in Healthcare Reform: Legal and Policy Issuess, The Commonwealth Fund, 12/31/2009
Allowing Multiple Insurance Exchanges in a Single Area Would Make it Harder to Obtain Affordable, Good-Quality Coverage (Adobe Acrobat PDF),Center on Budget and Policy Priorities, 7/8/2009
Implementation and Enforcement of Health Care Reform - Federal versus State Government, The New England Journal of Medicine, 12/30/2009
Health Exchanges: Different Political Railroad Tracks to the Same Station?, American Enterprise Institute for Public Policy Research, 9/4/2009
Virtual Health Insurance Exchange: Utah Goes Live, X Prize, 8/20/2009
State-Based Health Reform: A Comparison of Health Insurance Exchanges and the Federal Employees Health Benefits Program (Adobe Acrobat PDF),The Heritage Foundation, 6/20/2007
Health Insurance Exchanges: A Typology and Guide to Key Design Issues (Adobe Acrobat PDF),The Health Industry Forum, 7/20/2009
Letter to Harry Reid and Nancey Pelosi (Adobe Acrobat PDF),National Association of Insurance Commissioners, 1/6/2010


Sara Collins of The Commonwealth Fund explained the rationale for health insurance exchanges at the Jan. 8 briefing cosponsored by the Fund. (6 min.)

Timothy Jost of Washington and Lee School of Law discusses the similarities and differences in how the House and Senate reform bills deal with health insurance exchanges. From the Jan. 8 briefing cosponsored by The Commonwealth Fund.

Jon Kingsdale, exec. director of the Mass. Health Connector, discusses how lessons learned in his state could guide a nationwide health insurance exchange, or other state exchanges. From the Jan. 8 briefing cosponsored by The Commonwealth Fund. (14 min.)

Philip Vogel of the Connecticut Business and Industry Association described his organization's successful 15-year-old health insurance exchange for small businesses at the Jan. 8 briefing cosponsored by The Commonwealth Fund.


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