In the days ahead of the 2019 open enrollment season, one organization is suggesting that the Affordable Care Act exchanges would be better off if they were privatized.
The Council for Affordable Health Coverage (CAHC), which “promotes policies that lower health costs through increased competition, informed consumers, and more choices,” made the recommendation in a new review of the 2018 exchanges (PDF).
The federal health insurance exchange, Healthcare.gov, has a monopoly over where subsidy-eligible individuals can buy coverage in 38 states, as do state-based exchanges in the remaining 12 states, CAHC argues. As a result, they respond slowly, if at all, to consumer needs, the organization says. CAHC believes consumers would receive the information they need more effectively if multiple private platforms could compete against one another.
The federal data hub would remain in place. The private platforms would connect to it to maintain individuals’ demographic and income information, and the government would use it to oversee premium subsidies and ensure plan eligibility.
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The government would maintain oversight and functionality of the data hub “to minimize concerns over the possibility of reduced consumer protection” as well, CAHC wrote. Additionally, this approach would lower the government’s administrative and outreach costs, which have increased significantly since 2014, CAHC said.
Currently, consumers who want to purchase coverage off-exchange can buy it directly from an insurer or through a broker. CAHC’s report did not contrast these ways of buying coverage with buying coverage on an exchange, nor did it compare them to the hypothetical privatized exchanges.
Privatizing the exchanges has been a component of the Republican Party platform in recent years.
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In the same report, CAHC gave the exchanges letter grades and numeric scores. Eight out of 13 exchanges received a “D” or “F.” Several lack provider or prescription drug directories, and the out-of-pocket cost estimators featured on 10 exchanges do not provide “optimal decision-support,” the report says.
DC Health Link received the highest grade: 92 out of 100 possible points. CAHC dinged its out-of-pocket cost calculator for failing to consider the specific prescription drugs a consumer would need.
New York State of Health and Massachusetts Health Connector placed at the bottom of the list, receiving 55 and 48 points, respectively. Acknowledging this may surprise some readers, CAHC said “the poor performance of states inclined to regard the ACA less critically may reflect weak legislative oversight.”
With 81 points, Healthcare.gov ranked fourth overall; it also placed first in four subcategories.