One of the concerns that patient/consumer advocates have expressed regarding the formation of health insurance exchanges has to do with the potential conflict of interest that exchange board members might bring to the table. Of the nine members on the newly-formed Colorado health insurance exchange board, four are either insurance company or managed care executives, one is an IT executive with ties to some of the insurance companies already represented on the board, and one is an emergency room doctor who was adamantly opposed to health care reform. Consumer advocate groups have expressed concerns that the majority of the exchange board here in Colorado might have a conflict of interest in favor of insurance carriers rather than consumers.
Governor Hickenlooper’s office has expressed their confidence in the board members and has said there are no plans to replace any of them. But in states that have not created their exchange board yet, it might make more sense to appoint experienced, licensed health insurance brokers rather than insurance company executives. Consumer advocates might say that even brokers have a conflict of interest, but the PPACA has already settled the issue of whether we’ll continue to have for-profit health insurance companies. Attempts to create a single-payer system didn’t get far, and throughout most of the rancorous debate surrounding health care reform, all sides seemed to agree that our health insurance carriers are here to stay. So as long as most people are going to continue to be insured by private health insurance carriers, it makes sense to have exchange board members who understand the health insurance market. We cannot simply pull nine people off the street and have them on the exchange board simply because they are patients or health care consumers (all of us fit that description at one point or another). Having doctors and nurses on the board makes a lot of sense, since they are intimately involved with the front lines of health care delivery. But we also need to have people who understand the insurance end of the system, as the exchanges will continue to utilize the same health insurance model that we use now (with plenty of adjustments and regulations). Experienced brokers have a solid understanding of how the health insurance industry works, but are not tied to a particular carrier for their livelihood. So while there may be a potential conflict of interest in terms of wanting the insurance industry to survive, there isn’t a conflict of interest in favor of any one carrier.
It would make little sense to create a board of directors – tasked with setting up a health insurance marketplace – who had no experience in the health insurance industry. I can understand patient advocates’ concerns that the boards should be free of bias in favor of health insurance carriers, but we can’t have the board made up solely of people who are biased in favor of consumers either. If we create exchanges that are completely unappealing to health insurance carriers, the carriers might decide to focus their energies elsewhere (Medicare supplements, large group plans, etc.). In order to attract high-quality health insurance carriers to the exchanges, we have to make sure that the exchanges represent a business environment that is appealing to carriers. We also have to make them appealing and fair to consumers, in order to attract enough people into the exchanges. To work well, the exchanges will need to have a delicate balance between the interests of consumers, providers, and health insurer carriers, with no one group more heavily favored than another.