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Tuesday, October 1, 2013

High Excitement In Overlooked Part Of Health Care Rollout

One group of insurers opening for business today under the Affordable Care Act is out to change all of health care: health care cooperatives.

The co-ops are private non-profits offering insurance to individuals and small employers through the new health care exchanges. They emerged as a compromise, after Congress rejected a government-run insurance. They’re meant to compete with larger, commercial insurance companies.

The original idea was to have a co-op in every state, but Congress cut the start up funding, and only 22 co-ops open for business today, with another two expected to be up and running in the next few months.

Co-ops face several challenges, including limits on how they can spend their start-up money from the government. They are not allowed use it for advertising, for example, which presents a challenge in enrolling customers. They also lack the volume which would allow them to negotiate better rates with hospitals and drug companies.

Sabrina Corlette of Georgetown University Health Policy Institute, who thinks co-ops could be a good idea, wrote an analysis for Kaiser Health News lamenting co-ops’ disadvantages: “Unfortunately, the law forces these new plans to compete for market share with one hand tied behind their backs.”

Critics on the right say co-ops will end up wasting taxpayer money.

Despite the constraints, directors of the co-ops are optimistic and excited.

“We’re sort of in the eye of the hurricane right now. But it’s an exciting hurricane,” Janie Miller, CEO of Kentucky Health Cooperative told Kaiser Health News.

“We bring a completely different paradigm to health care finance,” John Morrison, president of the National Alliance of State Health Coops added. “We’re not interested in making as much money as we can. We’re not interested in making profits. What we are interested in is making consumer patients healthy and saving money.”

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  • Listener

    Why are insurance companies and these cooperatives limited by the state borders? I believe this is the case. It seems like a lot of confusion, paperwork and cost could have been saved. Groups could have been bigger and spread the cost over a greater number of people. Who benefits by having only in-State insurance companies?

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Robin Young and Jeremy Hobson host Here & Now, a live two-hour production of NPR and WBUR Boston.

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