North Bay Business Journal

Monday, February 4, 2013, 6:15 am

Insurance exchange a key, developing piece of health care reform


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    As full-scale implementation of health care reform nears ever closer, looming heavy on the minds of employers, insurers and health care providers, questions continue to swirl around numerous key aspects,  with California’s online health benefits exchanges high among the issues.

    Particularly, exactly how the state’s exchange — known as Covered California — will benefit employers is still being developed and realized by those who stand to benefit.

    The goal of Covered California, and other similar exchanges throughout the country, is twofold: to help residents without employer-based health insurance navigate the individual market and find affordable plans, and to similarly help small business achieve the same goal.

    The exchange will be broken up into seven geographic regions throughout the state, with all six North Bay counties falling into the Northern California region. In each designated area, Covered California anticipates on having no fewer than six health plans participate, and up to eight in Northern California.

    So far, 33 health insurers have have submitted a notice of intent to provide coverage in both the individual and shop-side exchanges, with five bidders proposing statewide coverage, according to an October update by Covered California. All health plans in the exchange must provide 10 essential health benefits.

    In the Northern California region, the exchange is projecting that, by 2014, a little more than 365,000 people will be uninsured, or about six percent of the area’s population.

    Much of the discussion on exchanges has centered on the individual side, chiefly because smaller employers, generally, are still figuring out their strategies on employee benefits.

    “We’re planning on being in both (individual and employer exchanges), but the expectation is that most of the enrollment will come from the individual side,” said Rick Heron, chief brand officer for Western Health Advantage.

    A good indication of that, Mr. Heron said, is that Covered California is estimating it will enroll up to 2.3 million individuals in health plans by 2017, while estimating for about375,000 small businesses with 25 or fewer full-time employees. Those businesses with employees who make an average of less than $50,000 per year will be eligible to receive a 50 percent federal tax credit through the Small Business Health Options Program.

    “That goes directly to the uncertainty of what small business owners will do,” Mr. Heron added.

    Enrollment starts Oct. 1.

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