Health exchange transparency coming, access next

June 27, 2014 

The opportunity for individual consumers to do comparative shopping for health care insurance is one of the benefits of the Affordable Care Act. People can pick insurance carriers and choose from a variety of plan options that fit their personal budget.

But the system only works if consumers have easy access to robust information, and until recently that wasn’t the case in the state of Washington.

After the initial roll-out of the state’s health benefit exchange this year, Insurance Commissioner Mike Kreidler heard from consumers who were upset to find their new health plan didn’t include their preferred doctor or hospital. The problem stemmed from ambiguity about the plans and how people could find the information they needed.

To fix the problem, Kreidler instituted a new rule that increases transparency for consumers. It went into effect prior to last month’s filing deadline for the 2015 state approved and regulated plans that people will pick from when enrollment opens again on Nov. 15.

Going forward, health insurers’ networks must have an adequate number of medical providers and facilities that can provide timely care and are located within reasonable proximity. The new rule also requires insurers to include medical providers who serve predominately low-income and otherwise medically underserved individuals.

And this information must be readily available

In a positive sign that the Affordable Care Act is working, the new rule caused little controversy among providers, insurers and others. In fact, insurance carriers responded by doubling the number of plans being offered for 2015, and the number of carriers offering plans through the exchange jumped by 50 percent, from 8 to 12.

The new rule makes a significant improvement for consumers trying to compare and pick the plan best for them or their families. But more work needs to be done.

It’s unlikely this information will be available on the health exchange website by November. This year, consumers will have to go to each insurance carrier to know precisely what providers are in or out of their networks.

That leaves an obstacle some will find frustrating.

We understand the technological challenges in getting each carrier’s medical provider information on the exchange website. It’s a late development and involves lots of data. And, although our state’s exchange was better than most, it still has some technical problems that annoy consumers.

But people won’t enjoy the full benefit of Kreidler’s new rule until all the information that people need to make their best choice can be easily found in one place.

The state health benefit exchange should double-down on efforts to make that happen as quickly as possible.

But give credit to the insurance commissioner for not waiting to provide more consumer transparency. It’s his job to monitor the marketplace and to create the tools essential for consumer protection.

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