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On the Third Hand: Plan data.

Byline: Allison Bell

The nonprofit, member-owned health insurance CO-OP in Nevada says that it's going to shut down at the end of the year.

The CO-OP in Louisiana is also shutting down at the end of the year. A CO-OP that served Iowa and Nebraska closed in late 2014.

On the one hand: Because the members of Congress who created the Patient Protection and Affordable Care Act of 2010 (PPACA) and the U.S. Department of Health and Human Services (HHS) officials who implemented the PPACA Consumer Operated and Oriented Plan program worked so quickly, with so many well-meaning but conflicting ideas, the rules governing the CO-OP program are an obvious mess.

If, for example, CO-OP organizers used some of the CO-OP startup loan money they borrowed from HHS to buy jewels and homes in Bermuda, throw the book at them.

If organizers just had a hard time starting a member-owned, nonprofit health insurer that can't legally get any financial or management support from an existing health insurer, and legally has no right to sell its operations to anyone, ever...Well, who wouldn't have trouble doing that?

Congress should bring the CO-OP managers, who can do that successfully, to Washington to give them candy, or, say, delicious, wellness promoting fruit smoothies, not punishing CO-OP managers who happen to lack the health plan management equivalent of world-class trapeze artist skills. Some lovely people aren't cut out to be trapeze artists.

On the other hand, the members of Congress who created CO-OPs said they wanted to give rise to a new type of health insurer that would put patients first, not obsess about those wicked profits.

Some of the PPACA public exchange programs, and especially the HealthCare.gov exchange program, have been disappointingly secretive. They release only cheesy press releases that, from the perspective of an executive lacking self-awareness, "make them look good," along with batches of exchange activity data that may look voluminous on paper but, in reality, give an incomplete picture of what's going on.

But the boards of other public exchanges, including the boards of the state-based exchanges in California, Colorado, Connecticut, Maryland, Minnesota, Nevada and Washington state, go out of their way to post regular, detailed reports on their operations, whether the results are good, bad or disastrous.

The big, publicly traded insurers publish quarterly earnings press releases, file detailed public quarterly financial reports with the U.S. Securities and Exchange Commission (SEC), and put their top executives on quarterly conference calls with securities analysts.

A look at the websites of most of the CO-OPs and most other non-publicly traded health insurers, with the exception of a few Blue Cross and Blue Shield plans, suggests that they mostly post...recipes. And press releases about how many cars their employees washed at the fundraiser for some nice charity last week.

HHS has not yet implemented the official HHS plan reporting and transparency requirements.

See also: Feds setting up new exchange plan reporting system

But even the smaller exchange plan issuers file quarterly statements with state insurance regulators.

Why aren't they, and, especially, the new nonprofit, member-owned, consumer-loving, paradigm-changing CO-OPs, all posting at least their 2014 annual statement PDFs in the "About us" sections of their websites?

The annual statements aren't packages of trade secrets. Even a small insurance company can have its accountants or lawyers go look up competitors' annual statements in a paywalled electronic database.

The only people who don't know what's in the annual statements are the consumers.

On the third hand, why should consumers have access to information about, say, whether the plans they're reviewing through PPACA public exchange systems are written by issuers that are, uh, financially sustainable?

Consumers should just sort the results by the monthly premium, minus the PPACA premium subsidy tax credit, and whether the logo is pretty and the radio ads are nice. Because that's all that really matters about a health plan. Right?
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Title Annotation:Opinion
Publication:National Underwriter Life & Health
Geographic Code:1U8CO
Date:Oct 1, 2015
Words:653
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