Health Exchange Board Delays Vote on Agent Issues

 

The California Health Benefit Exchange Board has delayed, until its Aug. 23 meeting, decisions on agent payment and involvement in individual and small-business exchanges.

Under the federal Patient Protection and Affordable Care Act (PPACA), every state is required to establish a health benefit exchange designed to make it easier, starting Jan. 1, 2014, for individuals and small businesses to compare plans and buy health insurance in the private marketplace.  The hope is that the Exchange will enhance competition and provide the pricing and competitive advantages enjoyed presently by large employer groups.  The law includes the individual mandate to purchase coverage, and also provides subsidieis for low-income individuals and tax credits for small businesses (defined, initially, as those with fewer than 50 employees) to help them purchase coverage.

No health plan is required to participate in the Exchange, but most health insurers support the exchange concept and are expected to participate--because the combination of the mandate, the subsidies and tax credits, and efforts to attract large uninsured populations, have the potential to bring in millions of new customers.  Every state is permitted to determine what "essential health benefits" must be provided under each of the federally designated bronze, silver, gold and platinum levels, but health plans will be required to offer the same standardized coverages whether in, or out, of the Exchange.

Federal law permits, but does not require, insurance agents to play a role in selling Exchange policies, but the architects of the California individual and Small Business Health Options Program (SHOP) exchanges have consistently stated they consider meaningful agent involvement not only desirable but essential to success of the Exchange.

The Board of Directors of the Exchange was scheduled to make final decisions on payments to agents in the individual exchange, on establishment of the SHOP exchange, and also hear preliminary recommendations on policies for benefit designs, selection and oversight of the health plans that will be offered through the Exchange, and requirements for an internal service center that would assist consumers directly.

However, discussion of parameters for "qualified health plans" ran substantially longer than planned, so other agenda items had to be postponed.

"Although many aspects of the PPACA are troubling, the organizers of the Exchanges in California have taken pains, at least so far, to ensure that agents have an opportunity to play a meaningful role in the operation of the individual and small-business exchanges here," said IBA West General Counsel Steve Young.

IBA West is part of a coalition--including the California Association of Health Underwriters and the National Association of Insurance and Financial Advisors-California--that has provided extensive oral and written testimony at Board meetings for much of the last year.

 

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