TRIO Blog

Seven months from the opening day of the Oregon State Exchange: The participating Carriers have been announced:

Written: April 3, 2013

HealthBy Leslie A. Thomas, CBWA

Whether you are an individual, self-employed, or small business owner, healthcare reform has already affected you in some way.    Do you know enough about your opportunities and responsibilities come October 2013?  Are you prepared?  Can you make heads or tails from what is being printed in periodicals or discussed within the media?  Ten months goes by quickly, let’s all make the effort to be as educated as possible.

Cover Oregon has announced today their approved carriers for the January 2014 HealthCare State Exchange.  This list is available for your review: www.coveroregon.com.  As I peruse the list of 22, I imagine many wondering where did these companies come from.  I am taken back by the large number of dental carriers involved, but then realize this is going to be a great growth opportunity for dental insurance.

I am also intrigued by the 2 CO-OP’s that are on the list, as well.  CO-OP’s are a new concept to our industry and Oregon is currently the only State in which 2 Federal startup grants were awarded $57 – $59 million.  Funding for CO-OP’s derived as a backup plan to the Affordable Care Act when the public option of the original bill did not receive the support needed.

“CO-OP”: Consumer Operated and Oriented Plan.  Under the Health Care Reform Act, and the Department of Health and Human Services, they are described as; “Private nonprofit health insurers whose boards of directors are made up of the customers of the CO-OP.”

  • Enrollees elect the board of directors, a majority of whom must be enrollees of the CO-OP health plan.
  • Profits are meant to benefit enrollees through lowering premiums, improve health benefits, improve the quality of health care, expand enrollment or otherwise contribute to the stability of coverage for members.
  • Educates enrollees about the plan.  Because a CO-OP relies on its enrollees to help decide the direction of the plan, communication about key features of the plan will be a high priority. Through expectations of engagement and communication with enrollees.

My optimistic side says; “Yea, Health Insurance utopia!”  It all sounds so warm and fuzzy.

My skeptical side says;

  • “Will having an enrollee elected board make that much of a difference?”
  • “This industry balances its profits and losses on high number of enrollees (ages 0 – 64), monthly premiums (income stream), enrollees lifestyle choices (claims risk), negotiated costs paid to healthcare providers (physician’s & hospitals).  Will not having stock holders, be the answer?”
  • “Plan design choices come through a carrier’s necessity to offset their current and expected risk.  Government mandates also dictate plan designs.  If you were to ask enrollees of any insurance plan today what they would change?  It would range from “nothing to everything”, all dependent on the individuals historical needs.”

I will meet in the middle and finish by saying; I welcome the addition of 2 health insurance resources for Oregonians.  I am hopeful they will accomplish profitability, repay the Federal Loan with interest as stated in the agreement, and provide desperately needed jobs to our local economy.


 

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TRIO - "Turning Risk Into Opportunity" We are all surrounded by risk. It's no wonder we can easily find ourselves consumed by our efforts to control risk and we can't see how the risks that surround us can be turned into opportunities. Here we will share what we have learned to help your organization look beyond the transaction of insurance and find the hidden costs within organization.

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