AHIP: Private Insurance Exchanges Will Prevail Regardless of SCOTUS Ruling

Margaret Dick Tocknell, June 21, 2012

Private health insurance exchanges will thrive no matter what action the Supreme Court takes on the matter of the Patient Protection and Affordable Care Act,. That's the collective opinion three panelists offered during a Wednesday session at the annual conference for America's Health Insurance Plans in Salt Lake City.

The future doesn't look quite as rosy for government-run exchanges, which could lose their funding mechanisms if the Supreme Court's decision results in significant changes to the Obama administration's healthcare reform law.

Private exchanges are commercial health insurance marketplaces typically run by insurers and employee benefit consulting firms. While government-run exchangess are very prescribed, private exchanges have more freedom to define the benefits and services they offer.

The panel looked at three potential Supreme Court outcomes and offered scenarios depicting how private exchanges would likely be affected:

Scenario #1: The ACA is struck down
"Private exchanges will have a future with or without national healthcare reform," says John Rich, CEO of NPH Health, which operates a private exchange with 150,000 lives in Massachusetts, New Hampshire, and Rhode Island. NFP Health was in business before national healthcare reform was enacted.

Rich explained that there's a strong push in the health insurance market to provide self service tools that enable consumers to access and manage their healthcare benefit functions and purchases. He says private exchanges are freer to meet those needs than government-based health insurance exchanges.

He noted that wellness programs are being weaved into private HIE and offer individuals and small groups access to a service they normally wouldn't receive. Also the private exchange platform can provide data about providers and hospital networks. Educational programs that are normally the purview of large companies with human resource departments can be scaled for small companies and individuals on a private exchange platform.

Chris Condeluci, an attorney with law firm Venable, with experience on Capitol Hill, notes that private HIE like NFP Health, existed before the healthcare law, so "obviously there's a market for them." He says private exchanges will survive even if the ACA is struck down because the exchange mechanism itself has bipartisan support in Congress. Condeluci served as tax counsel for the Senate Finance Committee when the healthcare reform law was being crafted.

Margaret Dick Tocknell Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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