The Health Insurance Marketplace

The Health Insurance Marketplace Effecting Purchasing Organizations and Special Group Arrangements

The Health Insurance Marketplace is supported by Governors efforts designed to enable small employers to join together to participate more effectively in the health insurance market. In fact, states have taken the lead in facilitating the development of such partnerships and alliances. However, these partnerships must be carefully structured and regulated by state agencies. Many states have experienced extensive and well-documented problems with fraudulent purchasing organizations in recent years. In many cases, state legislation has been adopted to protect against further abuse. The Governors strongly oppose congressional legislation that would extend ERISA status to, or otherwise limit state oversight of, Multiple Employer Welfare Arrangements (MEWAs), Association Health Plans (AHPs), HealthMarts, or similar arrangements. States have enacted health insurance reform laws, consumer protections that ensure consumers receive quality health care services from financially viable entities, and other standards to ensure that small employers and their workers receive reliable and secure coverage. Thus, exempting special group arrangements or other purchasing arrangements at the national level from state small employer health insurance reforms would destabilize the health insurance market by allowing unregulated entities to charge employers unlimited initial rates as well as increase their premiums on an unlimited basis due to employee illness.  Also, exempting these entities from state oversight would deprive consumers of important state protections and subject employers and consumers to increased fraud, higher costs,  and plan failures.

The Health Insurance Marketplace Supporting State Efforts to Provide Health Care to Underserved Areas

States are currently experimenting with a wide variety of initiatives that address the critical issues of increasing primary care practice and improving the distribution of primary care providers, especially in medically underserved rural and urban areas. These initiatives include data collection to better understand the distribution of, and need for, providers in specific locations; loan repayment programs to practitioners who practice in underserved areas; and technical assistance programs to enhance primary care delivery systems in underserved locations. The medical education system is not currently preparing the providers that are needed for a health care system that focuses on preventive and primary care. The Governors recommend that the federal government recognize, review, and support programs currently underway in states that are successfully addressing the issue of increasing and preserving access to primary care physicians in medically underserved urban and rural areas. Moreover, the Governors recommend that the federal government provide incentives for students, physicians, and mid-level health professionals to serve in primary care professions, particularly in those areas. The Governors further recommend that the federal government make a greater investment in health information technology (HIT) in underserved and rural areas, which would allow for improved communication and coordination with other aspects of the health care system resulting in greater efficiencies and improved quality of care.