What will insurance in the exchanges look like?

I was talking with some very nice insurance company executives and managers yesterday, and asked them about what they might offer in the exchanges.  It’s worth sharing some thoughts.

The media, and thus the country, are fixated on the politics at a national level.  I’ve argued before that’s missing the point, as much of this will happen at a state level.  But I think we have spent far too much time discussing repealing or defunding the bill, and not nearly enough on what still needs to be done.

For instance, we just told millions of people that they can go to the exchanges in 2014 and buy insurance.  There won’t be any lifetime or annual limits.  There won’t be denials for pre-existing conditions.  There won’t be any surcharges for having such conditions.  And it’s going to be “reasonably” priced.

I asked what insurance companies might offer under those conditions.  After all, if it were really that easy to offer comprehensive insurance at a real discount, someone would already do it.

Such insurance is going to have to come with restrictions.  There might be network restrictions (such as seeing only certain providers).  There might be gateways people don’t like.  And there might be other rules in place that people don’t anticipate.

My conversations lead me to believe that many people are expecting that the plans offered in the exchanges will be Medicare-like in many ways.  I feel like many people think they will have choice of doctor, choice of hospital, and the ability to dictate care.  I’m not seeing how insurance companies will be able to offer such products at prices people can afford.  As I talk to more and more people in the insurance industry, my thoughts seem confirmed.

I may be wrong, but I think it’s worth addressing.  Mistaken expectations have been, and continue to be, a real problem in health care reform.

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