Health Insurance Exchanges: House or Senate Style?

January 8, 2010

Health insurance exchanges can potentially serve a variety of policy ends, from promoting transparency and competition among health plans, to pooling or reallocating risk and administering subsidies for those unable to afford health insurance premiums. Exchanges can also play a role in health insurance oversight. Many of these functions are being carried out by the Massachusetts Connector, the exchange set up by that state’s reform law.

Both House and Senate reform bills include an exchange, but the proposals differ in several important aspects. This briefing, cosponsored by the Alliance and The Commonwealth Fund, considered those differences.

One major difference is that the House proposal would set up a national exchange, with states having the right to opt out; the Senate version envisions state exchanges. What are the strengths and weaknesses of each approach? How do the respective bills address the issue of risk adjustment? What powers does each grant to the exchanges in order to control premium costs? Who is allowed to participate in the exchanges?

These questions and more were considered by the panelists: Tim Jost from Washington and Lee University Law School; Jon Kingsdale, head of the Massachusetts Connector Authority; and Philip Vogel of the Connecticut Business and Industry Association. A new paper was available at the briefing (and now online below), written by Professor Jost and funded by The Commonwealth Fund, comparing the treatment of exchanges in the two bills. Sara Collins of Commonwealth and Ed Howard of the Alliance moderated.


Full Transcript (Adobe Acrobat PDF)

Speaker Presentations

Timothy Jost Presentation (PowerPoint)
Jon Kingsdale Presentation (PowerPoint)
Philip Vogel Presentation (PowerPoint)
Sara Collins Presentation (PowerPoint)

Event Details

Agenda (Adobe Acrobat PDF)
Speaker Biographies (Adobe Acrobat PDF)

Event Resources