Dive Brief:
- The federal government's proposed rules for 2017 aim to provide structure for plans on HealthCare.gov, which would limit the variables among plans and make them easier to compare in a way that is similar what what Covered California has done.
- The California exchange has blazed a trail in which it has acted as an active purchaser, determining which insurers can offer plans on the exchange, and what products are available at what price, Kaiser Health News reports.
- The federal government's aim is to improve value and simplify the shopping experience; the current process of offering unlimited options is difficult to compare plans.
Dive Insight:
The government's proposal to move toward standard cost-sharing designs in each metal level, though not mandatory for insurers, has been met with resistance from insurers due to the constraints it would introduce.
However, there hasn't been any complaint about the even more stringent system under Covered California, which includes a drug copay cap, requires all plans to be standardized, negotiates premiums and requires fulfillment of quality goals.
On the upside, California's structure has provided some security for insurers by laying out the playing field. On the downside, insurers haven't always agreed with the state exchange, and the rules have reduced competition by keeping some players off the field.
Experts suggest the government will be watching California and other state-based exchanges using active purchasing models.