RESUMO
Under the Patient Protection and Affordable Care Act (ACA), consumer choice plays a critical role: it drives the competitive market in health insurance plans that will operate through health insurance exchanges. As the 2014 deadline for establishing exchanges approaches, states face choices: they can either allow the federal government to manage an exchange on their behalf; take on a minimalist role by managing a state exchange or partnering with the federal exchange; or assume an activist role--by aiming to influence the price, design, and quality of the health insurance options available through exchanges and taking steps to support consumers' ability to choose among these options. This article discusses states' choices and the governance issues that they raise, first by describing the extent of discretion that states have in shaping the range of health plans on offer as well as the issues they will need to consider in choosing an exchange model. We then discuss the considerable body of evidence that addresses how people behave in individual insurance markets, concluding that it strongly supports the need for states to take an active role in shaping health insurance exchanges and ensuring that they support consumer choice.
Assuntos
Comportamento de Escolha , Trocas de Seguro de Saúde/organização & administração , Política , Comércio , Governo Federal , Trocas de Seguro de Saúde/economia , Trocas de Seguro de Saúde/legislação & jurisprudência , Humanos , Medicaid/organização & administração , Medicare/organização & administração , National Health Insurance, United States/legislação & jurisprudência , Patient Protection and Affordable Care Act/organização & administração , Governo Estadual , Estados UnidosRESUMO
Although the Affordable Care Act requires states to establish health insurance exchanges, states have considerable discretion in the exchanges' design and in the range of products offered. We argue for a more activist approach, based on the Massachusetts experience, which found that consumers want the exchange to act as a trusted adviser and to offer a reasonable set of choices, but not too many. These findings are reflected in the Medicare prescription drug, Advantage, and Medigap markets and in the Dutch and Swiss experiences, which validate the evolving approach of Massachusetts of limiting the number of options, standardizing products, and providing consumer supports.
