Health Insurance Exchanges – What Have We Learned?

Health Insurance Exchanges (HIEs) meld the social insurance goal of universal coverage and benefits with patient choice, competition among private health care plans, and incentives aimed at controlling cost and improving quality. But do exchanges deliver? Do they actually offer America's poor, unemployed, employees and employers good choices, hold down cost, and enhance quality? Or are they just a fad, or even a flop? The Affordable Care Act requires virtually all individuals to have access to a public HIE, and entitles low and moderate income-Americans to assistance in purchasing health insurance through HIEs, but the nature of exchanges has varied significantly from state to state. Meanwhile, mechanisms that resemble exchanges are expanding under Medicaid and continue as part of state employee health plans.  At the same time, non-governmental health insurance exchanges--aimed at larger employers--have suddenly emerged. What have we learned as a nation about the exchange experience? As experts on health coverage, what can we predict about the future of exchanges? Bottom line: Will more people have access to affordable and effective health care?

I. Moderator: Timothy Jost, Robert L. Willett Family Professor of Law, Washington and Lee University

II. The HIE concept — in theory and in practice

• Alain Enthoven, Marriner S. Eccles Professor of Public and Private Management, Emeritus, Stanford University Graduate School of Business: Before the ACA

III. HIEs Today: In the ACA Marketplace and Beyond

• Deborah Chollet, Senior Fellow, Mathematica: The HIE experience in the states  
• Joel Ario, Managing Director, Manatt Health Consulting:  Implementation questions encountered by the Centers for Medicare and Medicaid Services (CMS)
• David Riemer, Senior Fellow, Community Advocates Public Policy Institute:  The Wisconsin experience with government employee health plans

IV. The Future of HIEs, the ACA Itself, and American Health Policy

• Stuart Butler, Senior Fellow, Economic Studies, The Brookings Institution: What the ACA's waiver provision means for state-run exchanges in the future
• Len Nichols, Director of the Center for Health Policy Research and Ethics (CHPRE), Professor of Health Policy George Mason University:  What do HIEs mean for the future of health policy?

Q&A

Sponsored by the Wisconsin Health Partnership and the Community Advocates Public Policy Institute