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Life Health > Health Insurance

Use HealthCare.gov to settle risk corridor payment claims

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The chief executive officer of eHealth, Inc. recently reported hearing that some people in the Trump administration would like to try to kill HealthCare.gov, or at least get it out of selling health insurance.

To me, it seems as if that’s a bipartisan shame.

Of course, there are many bipartisan complaints that people can make about HealthCare.gov. It still, apparently, suffers from operational problems.

Related: Agents angry about unpaid ACA exchange plan commissions

Under former President Barack Obama, the Centers for Medicare & Medicaid Services was never very good about reporting on HealthCare.gov managers’ success, or failure, at meeting the original program goals, in a clear, concise way. It’s hard for a busy person to figure out how well, or poorly, HealthCare.gov does what it was supposed to do.

And, the obvious, bipartisan truth is that HealthCare.gov has been mean to eHealth and other Web brokers. It’s hard to know whether HealthCare.gov was so mean mainly because of regulatory limitations, technical problems or a belief that HealthCare.gov had to build a monopoly to succeed. But HealthCare.gov managers have never done a good job of sharing the health coverage enrollment sandbox with eHealth’s eHealthInsurance.com health insurance sales system or other web brokers.

Those web brokers developed the idea of selling health coverage online. HealthCare.gov came along, did the same thing, and never gave the existing web brokers the kinds of seamless enrollment tools that would have helped them compete with HealthCare.gov on an even footing. HealthCare.gov managers also failed to make any effort to prod insurers to pay commissions or service fees to any entity other than HealthCare.gov. In that respect, HealthCare.gov is kind of a jerk.

But, on the other hand, HealthCare.gov is a jerk with more than 10 million client relationships generating about $50 billion per year in premium revenue for health insurers, and maybe about $1.5 billion in exchange user fee revenue.

Right now, that business looks awful. But given how tangled much of the ACA system appears to be, it seems reasonable to hope that a moderate increase in regulatory system sanity could make the business profitable.

HealthCare.gov appears to be about 10 times bigger than eHealth, and investors have given eHealth a market capitalization, or total market value, of about $215 million. In other words: If the owners offered eHealth for sale, it might fetch more than $200 million.

Related: Why not sell HealthCare.gov?

If eHealth is worth more than $200 million, maybe appraisers would say that HealthCare.gov has a market cap of about $2 billion.

The U.S. government, meanwhile, owes billions of dollars in Affordable Care Act risk corridors program payments to health insurers. (The program was supposed to protect health insurers against the risk of the ACA exchange system having problems. Then the risk corridors program itself went kablooie, in a complicated way that stuck insurers with billions of dollars in unexpected bad receivables.)

Here’s a modest proposal:

          • Turn HealthCare.gov into a for-profit stock company.

          • Give 25 percent of the stock to web brokers, and regular brick-and-mortar agents and brokers, to compensate them for the recent ACA-related aggravation.

          • Give 50 percent of the stock to the insurers waiting for risk corridors program payments. That way, at least the insurers would get some compensation for all of their aggravation.

          • Put 25 percent of the stock in the Medicare trust fund, just in case it does well.

Then, hire whoever it is who makes exchanges like the New York Stock Exchange run smoothly to run HealthCare.gov, and see if the ugly duckling can grow up to be a profitable swan.

Allison Bell is a senior editor at LifeHealthPro.com.

Related: 

HHS promised full risk corridors payments, insurers say

Feds approve sales of failed CO-OP carriers

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