Health care is changing and so is the insurance system that facilitates payment of bills for health-care services. The Affordable Care Act will determine some of the future changes and some of the important changes are being determined by the Michigan legislature. Gov. Rick Snyder signaled his support for a Michigan-designed insurance exchange; the legislature has not acted on it. To meet the federal deadline the governor has filed with the federal government to have a joint (mostly federally designed) insurance exchange.
The devil is in the details. What will the exchange look like? It probably will be a website where consumers can go and purchase insurance from a list of options. How features and rates and consumer satisfaction will be shown is not known at this time. It could be shaped by state legislation if the legislature chooses to work on exchange legislation.
The Michigan House is working on legislation to change Blue Cross/Blue Shield of Michigan. The governor has supported this effort but as with all complex legislation, the devil is in the details. Blue Cross/Blue Shield insures about 70 percent of all people who have health insurance in Michigan. They were designed to cover Michigan citizens who had trouble finding health insurance as well as others. Therefore, they were granted non-profit status.
While they enjoyed this freedom from state taxation they accumulated sufficient capital to purchase the for-profit Accident Fund of Michigan. Now they have accumulated enough capital to offer payments for 18 years into a fund supporting health care in Michigan. To its credit, the House Insurance Committee is trying to design transparency into the legislation for this fund.
There are still important questions to be answered in construction of this legislation.
1. How can the data that Blue Cross/Blue Shield has on 70 percent of the market be used to determine who they will write and how much they will charge?
2. How much is Blue Cross/Blue Shield worth and are the ratepayers/citizens getting a fair price for the years of tax exemption?
3. How does the continued non-profit status which Blue Cross/Blue Shield of Michigan wishes to retain effect Michigan consumers and the price they will pay?
4. How does Blue Cross/Blue Shield’s changed status make their rate regulation different from or the same as other insurers under the proposed file and approve system?
5. How does this fit with provisions of the federal Affordable Care Act?
The devil is in the details.