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Connecting Americans to Health Insurance Coverage Overnight

The House passed its health reform bill earlier this month, and the Senate is considering similar legislation. Under either bill, how will the 46 million uninsured Americans — 6.7 million in California alone — be brought into the health insurance marketplace?[IMGCAP(1)] One hopes the answer is quickly and smoothly, but there are reasons to have doubt. What, if anything, can be done to speed up delivering on health reform’s promises?Our nation’s track record in implementing large-scale programs suggests we move deliberately down the field but rarely achieve the goal. For example, in the four years since the start of Medicare Part D, the prescription drug program, nearly 90 percent of seniors are enrolled in a sub-optimal (read: wrong) plan. About 10 percent of seniors still have no drug coverage. Medicaid and the children’s health insurance program known as CHIP have similar troubles, leaving millions of eligible Americans unenrolled.In his address to Congress on health reform in September, President Barack Obama suggested an online marketplace for Americans to find, compare and buy health insurance could be up and running in four years. Waiting until the end of 2013 would feel unbearable to those in need — like the life preserver that’s just out of reach.There is room for the private sector to help. We can transform delivery, the same way FedEx did for overnight mail and Domino’s did for 30-minute pizzas. Add in the high-tech power of California and the health marketplace will look dramatically different. Indeed, the technology to build the president’s online marketplace — called “health insurance exchanges— — already exists today.The concept of health exchanges was little known before 2008. Now it is widely accepted in policy circles that uninsured Americans will need such portals. Just as Orbitz does for travelers, private sector companies like mine have spent the last decade pioneering ways to create more competition among insurers and connect Americans to high quality, affordable insurance coverage.In Massachusetts, the state developed the Commonwealth Connector, which, along with other services, helps connect Bay Staters to coverage. In August, just as the president was speaking out about exchanges, the state of Utah launched its own. Today Utahans are going online to shop for health insurance through a number of technology solutions including those developed by eHealth Inc., the company I lead.It is important to note that while these two state efforts are significant developments, it was the private sector that initiated this movement and other important revolutions in health care and delivery. Indeed the private sector is answering the call of President Obama and others to develop cutting-edge technologies that reduce costs, increase efficiency and, most importantly, connect people to quality coverage. More than a decade ago, the first Web-based sale of a health insurance policy was made at federal policymakers hammer out health reform, it is essential that they continue to consult with innovative players in the private sector. With health exchanges and in other arenas, experience is a great teacher, and companies that operate at the intersection of health and technology have much to offer.Additionally, I believe that one exclusive national health insurance exchange would be an unwise approach. The bill just passed by the House gives states the opportunity to continue to create their own exchanges, which makes sense in such a diverse nation, and also allows consumers to access exchange-participating plans from eHealth and other enrollment avenues. The United States, with so many different communities and populations, requires many paths to coverage, including those that are online, in person, through affinity programs, schools, community centers, churches, brokers and agents — no single approach serves everyone’s needs. Sophisticated online exchanges like eHealth should be part of the solution. But we are only a part.With this in mind, policymakers have the opportunity to let government set the minimum rules for insurance policies, distribution channels and exchanges, and certify them. They can then empower states, independent brokers, online exchanges and others to display their different strengths in presenting choices and enrolling the uninsured.Passage of health reform is only the first step in helping those without coverage. It must be followed up with an aggressive, diverse and comprehensive enrollment plan — lest universal health coverage remain a promise, not a reality. With the right ground rules set by Congress, delivering quality coverage to 46 million Americans truly can happen overnight.Gary Lauer is chairman and CEO of eHealth, Inc., based in Mountain View, Calif.

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