Trend: Health Insurance Exchange Jessica Bertagnolli N621
When the Patient Protection and Affordable
Care Act were signed into law in March 2010, many changes to health insurance
went into effect. Some of the changes
include the subscriber not being charged for preventative services, children
with pre-existing illness cannot be denied coverage and parents can provide
health insurance for their children up to the age of 26 years (Department of
Insurance, 2012). Many of the policies
that are included in healthcare reform are aimed at increasing preventative
access and services, as well as providing options for appropriate health
insurance for as many individuals as possible.
Health insurance exchanges are another aspect
of healthcare reform that is currently being addressed in our nation. The purpose of insurance exchanges are to
provide access to health insurance for the masses, especially focused on the
uninsured, under-insured and those who buy private health insurance that is
non-work related. Again, this is another
part of healthcare reform that is focused on providing health insurance for as
many individuals as possible. Exchanges
are also aimed at changing the health insurance market by making it more
transparent to consumers (Focus on Health Reform, 2009).
A health insurance exchange is an entity that
provides consumers choices in health plans, making price comparison and quality
information available. This would allow
the consumer to make an educated choice with little sluth work needed to
determine if the consumer has coverage when care is needed. The exchange would also facilitate enrollment
and help to determine eligibility and provide subsides (Focus on Health Reform,
2009).
Rules for health insurance providers to be
more transparent could save the hospital money when considering administrative
costs in working with insurance companies to get paid for services. In my experience with utilization management,
as a nurse case manager, much time can be spent in trying to contact and
negotiate with insurance companies and in being the barer of bad news to the
patient when services are not covered.
Time is money and transparency could help to alleviate unnecessary time
spent away from discharge planning and care coordination, while in the
hospital.
Uninsured and under-insured patients that
require acute care may or not be able to afford to pay hospital bills. The hospital loses money when patients are
unable to pay for expensive hospitalizations and treatment. Exchanges would help to reduce the number of
uninsured and increase utilization of subsidies when appropriate. This would also help to decrease
administrative costs to the hospital by reducing the need for hospital
financial representatives and social workers to determine eligibility and
coordinate subsidies and other programs, such as Medicaid.
It is estimated that a total of 29 million
people will be enrolled in exchange plans by 2019 (Health Policy Brief,
2011). Insurance providers is largely
how healthcare providers get paid, so it would be of interest to the hospital
to be involved in and aware of policies effecting health insurance exchange
plans.
Each state has an opportunity to establish
their own exchange, prior to 2014, after which the federal government will come
to establish and manage one, as laid out in federal health reform
legislation. How the state sets up the
exchange is flexible and the state legislation can leave policies to be worked
out as time goes on (Health Policy Brief, 2011). This flexibility will allow for progression
as the program is grown and what works well is determined. It would be in the hospitals interest to be
involved in discussions about policy, as payment may be impacted. Also, funding of the exchange program will
have to come from somewhere (yet to be determined), and could fall as a tax on
health care providers (Health Policy Brief, 2011).
Department
of Insurance, 2012. Federal reform and health insurance in Idaho: Health
February 27, 2012.
Focus
on Health Reform, 2009. Explaining health care reform: What are health
insurance exchanges? The Henry J.
Kaiser Family Foundation, publication 7908.
Retieved from http://kff.org/healthreform/upload/7908.pdf,
on February 27, 2012.
how tough is hotel management?
ReplyDeleteInsight Learning Training Vault