The Centers for Medicare & Medicaid Services (CMS) seems to be doing more to at least look as if it will eventually implement the Patient Protection and Affordable Care Act (PPACA) health plan “transparency” provisions.
Meanwhile, in apparently separate, but, in my opinion, closely related news, CMS is saying it has problems with the data health insurers have sent in for a complicated new risk-management program, the risk corridors program, which is supposed to shift cash from health insurers that have good underwriting results in 2014, 2015 and 2016 to insurers that have poor results in those years, to help compensate for some of the effects of PPACA market changes.
CMS officials said they were spending more time validating insurers’ risk corridors filings and might make some insurers re-do their filings.
PPACA drafters had the idea that one way to turn consumers into better health care and health insurance shoppers was to give consumers more information about health plans.
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On the one hand, lawyers, economists and others have long, complicated discussions about the effects of transparency on competition. Some argue, persuasively, that poorly designed transparency programs can increase prices, by giving sellers the information they need to work together to keep prices artificially high.
On the other hand, one thing I do see as a reporter, and a patient (at least: I used to sometimes be a patient, before I ran into problems with talking to provider billing workers in an appropriate manner…), is that I have no ability whatsoever to understand what’s happening with medical bills, except, maybe, when I go to a drug store clinic or an independent urgent care clinic. As a reporter, I find that, a lot of time, getting even what is legally a public record is too difficult to be practical.
Originally, the U.S. Department of Health and Human Services (HHS) was supposed to have insurers post transparency information in 2014. They postponed implementing that requirement.
On the third hand, agents and brokers may benefit from the lousy flow of health plan information. Producers make money by bridging information flow gaps.
But, on the fourth hand, I think the situation is so bad that it keeps the public exchange system from bringing any free-market pressure to bear on the health care system.