EDITORIAL: Ohio addresses its exchange problem

Akron Beacon Journal (OH)

Aug. 02--John Kasich has been making the case to Congress, the Trump White House and anyone else who will listen: First, repair the exchanges where individuals purchase health insurance on their own. The governor has seen the problem up close in Ohio, where Anthem and Premier Health announced plans in June that they would exit the state, citing uncertainty about the support the federal exchange would receive.

That meant 20 mostly rural counties would have no insurance companies offering health coverage through the exchange, affecting roughly 11,000 Ohioans.

On Monday, the state Department of Insurance announced that, working with insurers, it has found a way to bring at least one coverage option to 19 of the 20 counties. Insurers already operating in the state will extend their presence to the counties looking at no options. Both the governor's team and the insurance companies have stepped up to the problem. (They continue working on the remaining county.)

This hardly is a complete repair to the exchange. Still, it is emblematic of the reality obscured by the hot talk about the exchanges spiraling to collapse. Again, the structure of the exchanges is essentially sound. What is required are adjustments, say, a better tool for attracting younger people, combined with sufficient backing to help the exchanges function effectively.

State regulators didn't stand aside. They rightly wanted to make the concept work.

It matters that four of the five insurers moving into the counties have Medicaid managed care plans. Individual buyers account for a tiny share of the overall market. Thus, it can be difficult in rural areas to build a network of providers.

State officials rightly stress that nothing yet is guaranteed. Insurers currently are weighing plans for next year. By the end of September, those participating in the exchanges must have a contract with the federal government.

President Trump could do his part to bolster the individual market by sustaining the $7 billion a year in cost-sharing reduction payments, money to help with out-of-pocket costs, such as co-pays and deductibles. The funding provides insurers with a needed degree of certainty and assists in keeping premiums in check.

The payments serve as a cushion against the unexpected in something new. Already lessons have been learned. States, for instance, increasingly see the value of implementing reinsurance, equipping insurers with a hedge against ending up with the most expensive patients.

Look at a map charting the performance of the exchanges across the country, and you find multiple choices of insurers in states as varied as Idaho, California, Michigan and Arkansas. The exchanges are a concept worthy of the time and effort to make them better. More, this is a marked advance over the individual market before the Affordable Care Act, when it served the healthy well but applied hardships to the sick, the coverage inadequate, even unaffordable.

John Kasich is right: Act to stabilize the exchanges, or they will unravel from neglect. Follow the spirit of the state Department of Insurance, and the fix can be made.

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