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How Competitive are State Insurance Markets?

The creation of quick jobs, as opposed to training, often results in the creation of too many bricklayers, often of not very good caliber. So that when the fund goes, people are no more able to get a good job than before. Sometimes there is a contradiction between building quality projects and using local labor, because when asked, municipalities often want quality projects. And yet bilateral and multilateral agencies say they want local labor to be employed. Finally, there are some environmental issues. Thousands of small projects may harm the environment and be hazardous to public health. Funds are often not prepared to cope with environmental problems. Very few of them. | Ijxixn FOCUS on Health Reform 1 THE HENRY J. 1 KAISER FAMILY 1 FOUNDATION 1 OCTOBER 2011 How Competitive are State Insurance Markets The Affordable Care Act ACA requires private insurers to deliver coverage to individuals and small businesses in more open and transparent insurance markets. Beginning in 2014 insurers will offer products with more comparable benefits and cost-sharing and they will be required to provide coverage to anyone regardless of pre-existing health conditions allowing consumers to more easily shop around for coverage. In addition new health insurance exchanges will facilitate insurance purchasing with the hope that enhanced competition among insurers will help to moderate premiums for individuals and small groups as well as for the federal government which will subsidize the cost of coverage for low- and moderate-income individuals buying through the exchanges. States must make many important policy decisions as they implement new insurance market rules and decide whether and how to operate exchanges. A number of these decisions may be influenced by how competitive a state s insurance market is perceived to be and the policy judgments states make can in turn affect how insurance markets operate and the cost of coverage. For example states establishing exchanges must decide whether their exchanges should be active purchasers i.e. able to exclude plans that provide lower value to consumers or be more passive accepting all qualified plans. States will be faced with a variety of competing considerations. On the one hand states with fewer insurers and less competition may lean towards a more active purchaser approach using the purchasing power of an exchange to counteract the market power of one or a few large insurers. On the other hand in a state with just one dominant insurer it could be difficult for an exchange - both economically and politically - to threaten excluding that insurer from participating in the exchange. State decisions .