As DC Gets the Green Light to Move Forward on Health Reform, Important Decisions Await

The District continues to prove that it is a national leader in health reform. Last week, the Federal government granted the DC Health Benefits Exchange conditional approval to begin operations in January 2014. This makes DC one of just nine states considered on track for delivering quality and affordable health insurance through the online portal within the year.

That is great news, but the celebration should not last too long. There is a lot of work to be done soon to ensure that the Exchange offers a solid set of health plans and that DC residents know how to use it to access affordable health insurance.

The heart of the Exchange is an online platform for offering health plans that meet certain quality standards. This will allow consumers to make true side-by-side, apples-to-apples comparisons of available health insurance options. Also through the Exchange, small businesses and individuals will be able to claim tax credits and other subsidies to help pay for premiums and out-of-pocket costs, essential steps to making plans more affordable.

Now that DC’s Exchange has been approved, its governing board must soon set the quality standards for health plans that will be sold on the Exchange. The board will need to address network adequacy ‘ making sure plans have an adequate number of providers ‘ an issue that many consumer groups have flagged. The board also will need to set limits in the variation of co-pays and deductibles for plans on the Exchange and set standards for annual caps on certain services. Getting these standards right is critical to ensuring that residents can afford and have access to needed care.

The District also will need to design programs that help consumers select the plan that best meets their needs and enroll in applicable subsidies. This includes creating a robust “Navigator” program ‘ a network of community assisters that provide outreach, education, and guidance on purchasing insurance through the Exchange. The District will soon have to select a vendor to build the information technology required for the Exchange portal to work. Finally, many District officials believe the DC Council will need to approve the Exchange’s proposal this spring to consolidate the insurance market for individual and small business health insurance plans under the Exchange.

Receiving federal approval for DC’s Exchange is commendable, and the Exchange’s staff and leadership should be congratulated for their efforts. With that said, the next few months will be a critical period in determining if the Exchange will be a viable market place for high-quality, affordable health insurance options that District residents and small employers need.

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