Crunching the numbers on health-benefits exchange

By Richard Asinof
Contributing Writer
One of the major reasons why Rhode Island has emerged in the forefront of health care innovation is it compact size: with its population of 1 million, its density, and its hospitals serving a mix of city, suburban and country communities, the state provides a workable laboratory to pilot new approaches, say health care industry observers. More

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Health Matters

Crunching the numbers on health-benefits exchange

PBN PHOTO/RYAN T. CONATY
BENEFIT STRATEGY: Health Insurance Commissioner Christopher Koller has warned that the the health-insurance-benefits exchange alone won't curb the cost of care.
By Richard Asinof
Contributing Writer
Posted 12/12/11

One of the major reasons why Rhode Island has emerged in the forefront of health care innovation is it compact size: with its population of 1 million, its density, and its hospitals serving a mix of city, suburban and country communities, the state provides a workable laboratory to pilot new approaches, say health care industry observers.

When it comes to crunching the numbers – how many Rhode Islanders will purchase health insurance products through a health-insurance-benefits exchange, and how many currently uninsured Rhode Islanders will be able to buy an affordable health insurance plan – the potential outcomes are much more difficult to pinpoint.

The most recent number of “covered lives” – the technical term used by commercial health insurers – that were reported to the R.I. Office of the Health Insurance Commissioner by the state’s three major commercial health insurers – Blue Cross & Blue Shield of Rhode Island, UnitedHealthcare of New England and Tufts Health Plan of Rhode Island – seem at face value, clear enough: 397,000 for Blue Cross, 147,000 for UnitedHealthcare and 15,000 for Tufts, for a total of 559,000.

But, the actual number of covered lives in Rhode Island is 605,000 – the difference of 46,000 is attributed to purchases of commercial health insurance from out-of-state insurers that Rhode Island doesn’t regulate, according to Deborah Faulkner, the consultant serving as project director of the state’s health-insurance-benefits exchange.

Part of the explanation is that many Rhode Islanders work in Massachusetts – and access to commercial health-insurance products has been predominantly defined by the workplace. For instance, included in Tufts Health Plan’s total of 15,000 covered lives are some 5,000 Rhode Island residents who work in Massachusetts, according to Tufts officials.

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