Will HealthCare.gov Get A California-Style Makeover? : Shots - Health News The feds propose taking a page out of Covered California's book and moving to a simplified marketplace for health insurance.
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Will HealthCare.gov Get A California-Style Makeover?

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Will HealthCare.gov Get A California-Style Makeover?

Will HealthCare.gov Get A California-Style Makeover?

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Healthcare.gov has been up and running for about three years now. And some three dozen states use it. Now federal officials are considering getting more involved in shaping the plans found there. The goal is to make it easier for consumers to shop for health care insurance. As Pauline Bartolone in Sacramento reports, the feds would be going down a path forged by California's marketplace, Covered California.

PAULINE BARTOLONE, BYLINE: California's philosophy is government should define the health plans for consumers, not the insurers. Charis Hill appreciates that. A couple of years ago, she was told her arthritis medication would cost $2,000 a month. She chose to be in pain instead.

CHARIS HILL: I felt like an invalid. I missed a lot of work.

BARTOLONE: That won't happen again in a Covered California plan. The state exchange told insurers they had to adopt a drug co-pay cap so consumers never have to pay more than $250 a month in a high-end health plan.

HILL: I could try a better treatment. It's kind of like the $250 is something I know that I can always fall back on.

BARTOLONE: Covered California also decides which insurers join the exchange, what the plans and benefits look like and at what price. All Gold plans, for instance, have the same cost for lab tests and doctors visits. Now the federal government may be inching toward that model. It says it has learned from the past few years that too much variety makes healthcare.gov offerings hard to navigate, therefore difficult for consumers to choose what's right for them.

SABRINA CORLETTE: Up until now, the federal marketplace has really taken a hands-off approach.

BARTOLONE: Sabrina Corlette with Georgetown University says right now, healthcare.gov offers any insurance product, as long as it complies with some minimum standards. The government is now pondering whether to be more selective. Corlette says that signals the government is ready to take a more active role.

CORLETTE: This is an entity that's going to work on your behalf with health plans to try to get you the best possible value, both in terms of price and then actually in terms of the quality of the product.

BARTOLONE: A simpler shopping experience could also make a big difference to insurance companies. In California, they like the standardized marketplace, says Charles Bacchi of the California Association of Health Plans.

CHARLES BACCHI: Well, it's been successful.

BARTOLONE: He says the state's stronger government role helps premiums stay more affordable. The clear ground rules are something insurance companies can plan around, Bacchi says, making it inviting for new companies to sell on the exchange.

BACCHI: Knowing that everyone was providing the same coverage with the same co-pays, the same cost-sharing, did provide some security.

BARTOLONE: But he says what works in California may not work nationwide. Marilyn Tavenner of the national trade association America's Health Insurance Plans says the timing is not right for more government involvement.

MARILYN TAVENNER: It's too early right now. We need to stabilize the products as they currently exist, encourage competition, get the pricing right and let the markets grow a little bit.

BARTOLONE: She says health insurers have been seeing financial losses, and co-opts have been going under. Others ask how something like co-pays can be standardized when health costs vary so much state to state. But customer Charis Hill says she appreciates California's more involved approach.

HILL: And keep reminding insurance companies that the reason they exist is to serve patients. And if they're not doing their job, then somebody's going to step in.

BARTOLONE: A new president will step in soon, a reason the administration may finalize these rules in the coming weeks. For NPR News, I'm Pauline Bartolone in Sacramento.

MARTIN: That story was produced in collaboration with Kaiser Health News and CALmatters, a nonprofit media venture exploring California policy.

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