Can a health care co-op be the answer to high healthcare costs? A story about a healthcare exchange, a small co-op and price transparency.
In NJ, if you tried and failed to buy health insurance on the national exchange that you can fully understand, you are not alone. Many reports show that healthcare costs are slowing, yet, each year, small employers are seeing their bills buying health insurance for themselves and their employees are going up.
Many states set up their own exchanges so you can buy insurance, however, there have been many problems in some states, while others have worked reasonably well. In Maryland, their state exchange had worked poorly. A local doctor organized a state healthcare co-op, set up a marketing budget, and as the deadline approached, only had about 650 members sign up. Part of the problem is that their exchange was not working well. The other part of the problem is that plans that appeared to be cheap (low monthly costs with high deductibles) sold well, but also pushed their plan way down on the list. This was not advantageous for a new plan that wants to offer a better coverage, with low copayments and deductibles and coverage for healthy lifestyle choices since that plan by design would be more costly, but not as costly as a similar plan from one of the larger healthcare networks.
In NJ, not all plans participate in the exchange so consumers have little choice. We do have a non profit Co-op plan designed to cost less, and be exclusive to the exchange called Health Republic. Health Republic is exclusive the NJ, NY and Oregon. As taken from their site, here is a description of how Health Republic developed.
“Health Republic is an idea of the Freelancers Union. Freelancers Union has been advocating for the rights of independent workers and underrepresented Americans since 1995 as well as providing insurance for more than 24,000 members in the New York City metropolitan area.”
This plan, if you check in the NJ exchange has markedly lower rates, using the Qualcare Network. There are limits to what this plan will do and there are no out of network benefits, since these plans are EPO plans. I do not endorse this plan however, you may wish to check it out. Please be aware of some significant limitations but the plan does offer lower co payments and deductibles than other similar looking plans.
Read about the Maryland Co-op here
Maryland online exchange problems cloud doctor’s vision for health care
By Jenna Johnson, Published: March 7
Peter Beilenson dreamed of bright, affordable health-care centers in working-class neighborhoods, staffed with doctors paid a flat salary — rather than per patient — and lifestyle coaches encouraging healthier living.
Tiny waiting rooms would reinforce the message that all patients would be seen quickly. A human would always answer the phone. Specialists could immediately be consulted by videoconference. And there would be free yoga.
Such common-sense approaches, Beilenson believes, will eventually drive down health-care costs. Buried in President Obama’s newly enacted Affordable Care Act, he found a way to test that theory. But because of hard-to-resolve problems with Maryland’s new online health exchange, his experiment may be in jeopardy.
Beilenson, a physician who has spent his career improving public health in Baltimore City and Howard County, used federal loans set aside for nonprofit insurance providers to launch Evergreen Health Co-op, a hybrid creation that provides insurance coverage and health centers.
In the past, such a start-up could never have competed with industry giants such as Maryland-based CareFirst BlueCross BlueShield. Now, the online marketplaces mandated by the health-care law are supposed to make it easier for customers to browse plans and pick what best fits their needs.