Obama Promises Better Health Care Exchange Plans in 2015

Health Care Exchange

“The plans are too expensive, there aren’t enough doctors or hospitals to choose from and the prescription drug options are too limited.”

These are the types of complaints the White House has received from consumers about health insurance plans offered through Healthcare.gov. The Obama administration is taking these complaints seriously by issuing new rules that promise greater oversight and scrutiny on plans looking to partake in the health care exchange next year.

Problems with Health Care Exchange Plans

According to the The New York Times, the Obama administration points to poor oversight for the problems, relying on information from state exchanges in approving plans for inclusion in the health care exchange. Many plans currently in the health insurance exchange have tried to keep costs down by limiting the number of doctors and medications available, but this is problematic for individuals with complicated medical problems such as cancer or mental illness.

Under the new rules, health insurance companies must include access to 30 percent or more of local health centers, H.I.V./AIDS clinics, family planning centers, pediatric hospitals and hemophilia clinics. In addition, insurers will have to provide links to current medication lists directly from health care exchange sites, and must indicate which doctors are accepting new patients.

New Health Insurance Rules to Protect Those with Complicated Health Issues

The Centers for Medicare and Medicaid Services (CMS) are responsible for determining whether plans meet the new health care exchange standards. According to their most recent guidance letter to health insurance companies, the CMS will still rely on states to review plans for compliance but will not rely on state-provided reviews when making a final determination.

Instead, the CMS will review state assessments of insurance plans, work with the state to clarify any potential problems, and then make the final ruling on whether a plan qualifies for the health care exchange.

A full CMS list of rules and health plan standards guide is available on their website. These resources cover several different programs administered under the Affordable Care Act, including the Agency’s plans moving forward.