So HealthSource RI is up and running. At least comparatively speaking, it seems quite successful at this early stage, too, managing encouragingly high traffic, facilitating registration, and even enrolling new subscribers. In the first week of operation, the site enrolled about as many new subscribers as neighboring Connecticut, which draws from a much larger population. It would seem that Director Christine Ferguson and her small but intrepid staff deserve at least preliminary kudos for the frenetic effort needed to get the massive project off the ground on time.
Reform advocates see the exchange as a powerful tool in the struggle to rein in future health costs, and as a result, the escalation of health premiums that have bedeviled the business community for years, spiraling upward at double the rate of inflation for more than two decades.
But of course there are always detractors, the glass half-empty folks who raise questions and issues about what could go wrong. They also serve an important purpose of course, keeping the effort focused not only on what has been accomplished, but what remains to be done. They point out that as neither an insurer nor provider, the exchange is another intermediary. It must prove that its value to the system exceeds the cost of operation.
At the recent Publick Occurrences event on Obamacare at Rhode Island College, a spokesperson for the broker community was sharply critical of the exchange, pointing out that it will cost the state about $25 million annually to run after federal funding runs out in 2015. To date, no self-sustaining funding source for the exchange has been identified.
Of course there are ideas, the most obvious being a fee or tax of some sort on the premiums of policies purchased, or a charge on claims made under those plans. Since both of these functions already occur in the present system, the fees to the exchange would add to current costs. Since the savings benefit of streamlining and the group-purchasing effects of the exchange are yet to be quantified, this leaves the question of the exchange’s value proposition open.
An important piece of the mission of the Affordable Care Act from which the exchange was created is to expand health-insurance coverage in order to reduce the enormous burden of uncompensated care in our system today. In Rhode Island we know that our hospitals spent more than $160 million at their cost (not charges) last fiscal year providing this care. Presumably other health providers suffer proportionately from treating patients that can’t or don’t pay.