Surprises in the Proposed Exchange Regulation

On July 11 HHS released the proposed Exchange regulation that will govern the new health care marketplace beginning in 2014.  One of the issues that surprised me was the lack of detail on consumer protection. 

While there are many and perhaps even competing provisions impacting consumer information e.g. from the Exchanges, call centers, new Navigator programs, and agents and brokers, there are few regulatory requirements on consumer protection. 

As I read the proposed regulation, the QHP marketing practices and consumer appeals will be governed by state law and state insurance department oversight.  While many states do an excellent job in these areas, we know from the Medicare Advantage experience that there were many undetected marketing abuses due to lack of state resources to oversee and enforce requirements.

Given current and worsening state budgetary situations, there may be a need for careful monitoring of early warning signs of consumer problems in the new Exchanges and qualified health plans.  Consumer complaints and appeals should be the canary in the coal mine.

Jean LeMasurier
Jean LeMasurier

Jean LeMasurier is Senior Vice President of Public Policy at Gorman Health Group (GHG). In this role, her focus includes health policy and health care reform, including changes resulting from the Affordable Care Act (ACA). Jean’s strategic planning and consulting services have been critical inputs to strategy for Medicare Advantage (MA) Health Plans and Prescription Drug Plans (PDPs), Medicaid managed care plans, pharmaceutical companies, and employers on legislation and regulatory impacts of changes in Medicare and Medicaid. Jean brings GHG clients more than 30 years of experience with the Centers for Medicare & Medicaid Services (CMS).

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