Debrief: What's Ahead For RI's Health Exchange

Oct 17, 2013

HealthSource RI has been up and running for a couple of weeks now. And it’s where uninsured Rhode Islanders and small businesses can find a health plan – which they’ll need to do by January 1st. The head of HealthSource RI –Christy Ferguson—briefed state lawmakers yesterday on how that’s going. And Rhode Island Public Radio health care reporter Kristin Gourlay was there. She joined afternoon host Dave Fallon in the studio to talk about what Ferguson had to say to lawmakers.

KRISTIN: In a nutshell: she says it’s going well, better than expected even. That’s in contrast to the federal health insurance exchange operating in states that decided not to build their own. And Ferguson seemed pretty proud of that. Now she says the task is to continue to reach out to get even more people on the exchange. More than 50,000 have visited so far. Almost 10,000 have called their call center. And nearly 6,000 have at least created accounts on the site.  But only about 1700 have actually completed an application.

Employees taking calls at HealthSource RI's call center in Rhode Island.
Credit Flo Jonic / RIPR

DAVE: And for those of us who haven’t gone on the exchange, what will we find there? What’s the application process?

KRISTIN: Remember, the exchange is for people who either don’t have health insurance or whose insurance through an employer is not affordable – meaning it costs more than nine percent of your income. The exchange is also for small businesses, who have their own section on the exchange. So here’s what you’ll find: you go online and create an account. The system verifies your identity. You plug in your name and age and the system comes up with a list of options for you. There are 28 plans to choose from – 12 of those are for individuals, and 16 are for small businesses. There are also some dental plans. And you can compare everything side by side. Then you sign up for one and pay for it.


DAVE: Speaking of paying - some people will qualify for a federal tax credit - or subsidy - to help defray the costs of a plan. Some won’t. But isn’t the affordable care act supposed to bring prices down in general? If enough people get in on the exchange, could that bring down prices?

KRISTIN: It could help, but it’s not going to happen right away. The head of HealthSource R-I, Christy Ferguson, explained to lawmakers that, first of all, this is just the first draft. This is the exchange’s first year. But going forward, she says they’ll re-negotiate prices and plans with insurers – and that seems to me to be one benefit for consumers of buying on the exchange. You’ve got this collective bargaining power. But Ferguson also explained that what’s really going to bring down prices is not just more customers but changing the way you get your health care. Maybe your plan offers you a bit less choice in terms of which doctors you can see in exchange for lower prices. Or maybe they give you the option of seeing a doctor who’s paid one flat fee to keep you healthy, instead of a bunch of fees for each little service and procedure. And she says when you go on the exchange to shop for a health plan, you should start to think about these kinds of things. Look at more than just the monthly premium or deductible. Look at how the plan delivers your care. Here’s Ferguson walking state senators through it.

“What’s the provider network? Is it an HMO? Does it highlight primary care? There are a variety of different things. And over time, over the next year, I see this, how you get your care, as being built out, because that’s where we want people to focus. That’s where we really have the best ability to manage price.”

DAVE: And isn’t Rhode Island one of the only states offering what’s called “full employee choice” on its exchange?

KRISTIN: Exactly, Dave. And here’s what that means: employers with 50 employees or fewer can buy a single plan for all of their employees. Or they can say ‘OK, here’s how much I’ll contribute to your monthly premium, apply it toward whatever plan you want, oh employee of mine, on the exchange.’ That’s really different from how most employers do things today.

DAVE: So what’s ahead for the exchange? It’s got to find the funding to keep operating. And it seems to me that it still has some work to do to get the word out.

KRISTIN: I think you’re right. On the funding side, Christy Ferguson says they’re still working that out with the governor and next year’s budget. They’ve got federal start-up funding, but beyond that it isn’t clear what they’re going to do. As for getting the word out, there is an ad campaign. And there are lots of community organizations engaged in educating people about the exchange. Ferguson told lawmakers she’d be happy to help them organize Q and As with their constituents.

DAVE: Alright, thank you Kristin.

KRISTIN: You’re welcome, Dave.