While senators battle on Capitol Hill this week about the Senate Finance Committee's health reform proposal, I'm left wondering what will actually stick.
Will the public option make it through the sausage factory on Capitol Hill? I don't think so. Will health reform include meaningful cost controls? That's possible, but not probable.
One idea that could make it as a compromise to the public option and insurance co-operatives is an insurance exchange that could be run federally or more likely at the state level with seed money from the feds.
The benefit to the insurance exchange is that there is a test case at the state level. As part of its massive health reform plan in 2006, Massachusetts created the Commonwealth Health Insurance Connector Authority, which oversees the reform effort.
A key part of the program is the insurance exchange Web site that allows Bay Staters to compare available health plans by costs and benefit designs. Federal policymakers and health leaders can learn from the Massachusetts program when creating an exchange.
Greg DeBor, a partner in CSC's Healthcare Group, partnered with the commonwealth to develop the Connector Web site, and coauthor of a white paper about the Massachusetts experience, says The Bay State's experiment is the "best learning lab for policymakers on the Hill."
Here are four lessons from Massachusetts' insurance exchange:
If you don't require coverage, don't expect many to sign up
As I wrote in March, I am surprised the individual mandate is still even part of the debate. It's not that I don't think it's a good idea, but when Hillary Clinton withdrew from the presidential race last summer, I thought any hope of an individual mandate left with her.
At the time, both remaining major presidential candidates were against the idea, but President Barack Obama now says he's open to the individual mandate as part of a larger health reform package.
Requiring everyone to have health insurance will be a tough sell in Congress, but the Massachusetts experience shows that the mandate is needed if lawmakers expect millions—especially the young and healthy—to buy insurance.
Massachusetts officials found that the uninsured didn't flock to the Connector Web site to find a plan until they were required to buy insurance or face a fine.
In other words, if you don't force people to buy health insurance, they will find more enjoyable ways to spend their money.
DeBor says a mandate would "make it easier."
"People simply weren't looking for a simpler way to buy insurance and then rushed out and bought it. They had to be told that this was required of them," says DeBor.
Educate prospective members about healthcare and health insurance
When creating the exchange Web site, Massachusetts learned education was the first step—and not just education about the plans that are available. They needed to know the very basics. What is insurance? What's a premium? How do you find a doctor? These questions are common knowledge to the insured, but for those without insurance they are foreign concepts.
Program officials had to first tell the uninsured about insurance and why they needed it—and speak at a level that everyone could understand. Plus, for those shopping for individual health insurance, program leaders needed to educate people who were covered through an employer previously about the individual health insurance market.
Plan for an extensive marketing campaign
DeBor says two of the biggest keys to the Massachusetts exchange have been marketing and Web site design. He adds the two work in concert to deliver the education piece, both about healthcare and the individual mandate.
Massachusetts was inundated with marketing about the reform program in the months before the coverage deadline. There were countless commercials, ads on sides of buses and billboards, and collaboration with Boston sports teams to promote the idea.
As I mentioned earlier, this education included not just information about the mandate, but also explained the healthcare system, the definition of health insurance, and why—nearly every Massachusetts resident must have it.
Expect future enhancements
Once the insurance exchange is created, don't expect that the shiny new Web site means the journey is over. Massachusetts has also improved the site through enhancements, such as a benefits calculator and plans to add Web 2.0 offerings, such as a list of what other people are buying.
The redesigned Web site also separates the pathways for users depending on the customers' needs (such as whether they are searching for an individual or subsidized plan). This allows the individual purchaser to navigate easier.
As these insurance exchange tips show, approving a new health reform law is the easy part. If a comprehensive health reform plan actually makes it through Congress this year, policymakers and health leaders should remember these items from Massachusetts and spend a great amount of time studying the Massachusetts experience and learn from both its successes and failures.
But it's not just policymakers who can learn. Health insurance plans that are looking to promote their individual offerings should also learn from Massachusetts. That learning will become more important as the employer-based health insurance market continues to erode.