Stairway to….Ohio’s Health Insurance Exchange

Was watching the Kennedy Center Honors last night. Led Zep was being honored. I realised that I’m old (Heart sang Stairway to Heaven) when bands from when I was in high school were honoring a band when they were in grade school. We’re all going to get old and fast. Probably why I have been asked by my colleagues and friends about the changes in healthcare insurance and the new exchanges that will be coming in to force soon. Many are worried about the changes. Somebody mentioned to me that that they don’t believe that pre-conditions will be overlooked from now on. There are a lot of ambiguities in the way the exchanges will operate. I feel that it comes with any major paradigm shift in thinking.

Change is not the most welcome thing individuals welcome, least of all something that affects their health care. Essentially, the exchanges are new organizations that will be set up to create an organized market for people to purchase health insurance. They are supposed to offer a choice of different health plans, as well as certifying plans that participate in the exchange and provide information to help consumers better understand their health insurance options.

From 2014 onwards, these exchanges will primarily serve individuals looking to buy insurance on their own and small businesses with up to 100 employees, though states can opt to include larger employers in the years to come. States are expected to establish Exchanges or can ask the Federal Government to do it for them and they can be a government agency or a non-profit organization. In addition, states can create more than one exchange, as long as only one serves each geographic area, and can collaborate to build regional exchanges. As it has been reported in the media, on November 16th, 2012, the Governor of Ohio told federal officials that Ohio would have a federally-managed health insurance exchange. The caveat is that the state would keep control over its insurance industry. Governor Kasich additionally indicated that Ohio would maintain control over eligibility for Medicaid.

Before the announcement, the Department of Insurance, working with other agencies solicited assistance for the first year of exchange planning and implementation. Qualified health plans purchased through an exchange in Ohio are prohibited from covering abortions, except in cases of rape, incest, or to avert death of the pregnant woman.

Essential Health Benefits (EHB): The Affordable Care Act (ACA) requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Ohio has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Community Insurance Company (Anthem Blue Cross Blue Shield)- Blue Access PPO. The funding for the exchange started in September of 2010 when the Ohio Department of Insurance received a federal exchange planning grant of one million dollars.

The Federal Government will be responsible for running the health insurance exchange in Ohio beginning in 2014. Ohio must submit a blue print of plan management functions if it wants to take over responsibility the exchange to the Department of Health and Human Services by the 15th of February, 2013. Additionally, much of the above information is available through the Kaiser Foundation website. A great source of information for everyone.

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