McInerney: A very Virginia health exchange

The Affordable Care Act (ACA) has been law for almost a year and millions of people are seeing the benefits. Insurance companies can no longer deny coverage to children because they've had cancer, diabetes or another pre-existing condition. Young adults can remain on their parents' policies until age 26. Seniors are getting help paying for medications.

Now, Virginia and other states are taking steps required under the Affordable Care Act to create marketplaces where people will find an array of affordable, quality, private health insurance options and can purchase a plan that meets their needs.

Under the new law, each state must begin operating a health insurance exchange in 2014 that allows individuals and small businesses to purchase health insurance from various carriers. States have two options: Design and establish their own exchange — as Virginia is doing — or accept the federal government's design. A bill in the General Assembly stating that Virginia intends to create its own state-run exchange is poised to become law, with broad, bipartisan support.

Virginia families are on a path to having better, more affordable health care so crucial to leading a productive life. But you wouldn't think so after reading a recent opinion piece ("Don't open a state health exchange," Sunday, Feb. 13) on these pages by John Graham of the San Francisco-based Pacific Research Institute. His argument that Virginia should stop moving forward with reform revealed a lack of understanding about what's actually happening here, and how the exchange will benefit Virginians.

Graham incorrectly asserts that Gov. Bob McDonnell and Health and Human Resources Secretary Bill Hazel have ceded control of the health reform process to the Virginia Health Reform Initiative (VHRI) and its 24-member advisory council. In fact, McDonnell created the VHRI and put Hazel in charge of its work.

And while it's true that Attorney General Ken Cuccinelli (with the governor's support) is challenging the individual mandate provision in the new federal law in court, Hazel acknowledges that Virginia needs to reform its health care system and should be prepared to implement an exchange if the legal challenges fail.

There are ways to improve on the McDonnell administration's approach. For example, the VHRI should include consumer voices on the advisory council. And the VHRI should remain vigilant in designing an exchange that provides affordable options, protects consumers, and is self-funded and sustainable. Otherwise, affordable, comprehensive health insurance won't be as widely available as it needs to be.

But Graham's views notwithstanding, the changes in Virginia and across the nation are far from extreme. Health insurance exchanges will give Virginians now shut out of the insurance market a new way to buy coverage. Many Virginians don't get insurance through their jobs, and the current individual market doesn't offer a viable alternative. Only about 5 percent of Virginians purchase coverage in the individual market because the premiums often cost too much and insurance companies can deny coverage to people with health problems. Small businesses also fare badly because of costly premiums. Only 37 percent of Virginia businesses with fewer than 50 employees even offered health insurance coverage in 2009.

A health insurance exchange will offer individuals and small businesses more choices at lower costs. The exchange website will provide information on plan options to help consumers make informed choices. Subsidies will assist people who can't afford the full price of insurance offered by private carriers in the exchange, and people eligible for other public supports, such as Medicaid or children's health insurance, will be enrolled in these programs. That's not the government-control plot Graham seems to want to scare people into thinking exists. It's a rational, cost-effective way to help people be healthy, productive citizens.

Many key decisions remain involving exchange governance, maintaining affordability, and working toward making the process open in ways that protect and inform consumers. The state will need to reach consensus on these and other issues before the 2012 General Assembly session in order to have enough time to gain federal approval and implement the exchanges before the Jan. 1, 2014, go-live date.

A process for creating a successful health insurance exchange that provides Virginians with affordable coverage is moving forward with the support of state leaders, including the governor and his Health and Human Resources secretary. The law requires creating an exchange, and we must be prepared with a plan that suits the needs of Virginians.