Consumer organizations may find opportunities to partner with health plans in the coming years as more health reform changes take affect in the coming years.
Consumer groups are beginning to understand that changing the way health care is paid for and the way it is organized can improve quality and efficiency, said Sabrina Corlette, research professor at Georgetown University's Health Policy Institute.
"Increasingly, consumer groups recognize this as an area that they need to get into, so it presents opportunities in which they could partner with health plans," she said at an Oct. 6 conference sponsored by America's Health Insurance Plans. Insurers can also structure benefits so that consumers have incentive to change behaviors to get more value from their care.
While the Patient Protection and Affordable Care Act is fundamentally changing the health insurance marketplace, it may also change how plans' traditional stakeholders, such as consumers, small business and independent insurance broker/agents, engage in assuring access to coverage.
For example, consumer groups can collaborate with plans to make sure that the individual mandate is applied effectively, whether for healthy individuals who might not otherwise buy insurance or those populations who have traditionally been underserved, Corlette said.
These organizations already have relationships with different communities through their membership and issue activities, such as around safety and access.
Consumer groups could also partner with insurance exchange navigators called for by the health reform law and traditional independent insurance broker/agents. With millions more individuals about to access health care, "we'll need all hands on deck" to guide and enroll them, Corlette said.
Under the health reform law, navigators are meant to provide public education and give "fair and impartial information" about insurance coverage and plans without consideration of the insurer in order to enroll individuals and small employers.
However, insurance broker/agents have expressed concern that navigators may encroach on their business, said Jessica Waltman, senior vice president for government affairs, the National Association of Health Underwriters (NAHU), which represents health insurance agents and brokers, who primarily serve small business owners. NAHU members are typically the owner or principal in an independent insurance agency.
Many brokers have products that may not be eligible for the insurance exchange because they are aimed at specific situations. And many of the newly insured likely will not be able to afford their products.
"Navigators and brokers both bring people to the table for enrollment, but brokers provide a service role for the customer," Waltman said. Broker/agents work on issues and problems that arise throughout the customer's coverage contract.
About one half of small businesses of up to 50 employees offer some type of insurance plan. From the health plan perspective, the challenge is to maintain the coverage products that are currently available to the small group market, said Amanda Austin, director of federal and public policy for the National Federation of Independent Business (NFIB). The organization has joined with 26 states in a lawsuit to overturn the health reform law.
The goal would be to raise premiums at renewal only at, for example, general medical inflation or identify levers that health plans have to allow an employer to pool around higher deductible or co-pay levels. "These are the levers that small employers use all the time on the fully insured side of the market," she said.
However, for an uninsured firm that may want to offer coverage, especially in 2014 as a product of the individual mandate, "I think it's an uphill battle to be a newly offering firm," Austin said. The small business needs to have high participation rates to make it worthwhile.
Most low-wage firms that operate with a temporary workforce or attract young, entry level employees, they're not offering coverage for a variety of different reasons, and the employees prefer higher wages more.
"The individual mandate is going to perpetuate some of that pressure, which is a good thing in general to secure coverage for everyone. But it's going to require some tough decisions on the part of employers," Austin said.
Health plans are going to have to figure out how to maintain current offer rates and how to work with the employer community that doesn't offer coverage to see if it's affordable or not. The law puts a lot of constraints on industry on what they can and cannot provide for small businesses that typically don't self-insure, she said.