This is a pretty good example of how much more weight corporate lobbyists have than the handful of groups like OSPIRG and citizen lobbyists have in the legislature. The problem is far worse at the federal level.

For whatever its worth, our members are overwhelmingly supportive of legislation to better protect ratepayers and consumers from insurance companies, and that is true whether they identify as liberal, conservative, or anywhere in between. There is no downside, electorally speaking, for protecting Oregon consumers.

I would encourage any member of the House health care committee who took the IPO nomination in 2010 to listen to OSPIRG's concerns and try to accommodate them in this legislation.

I couldn't have said it better!

listening to Dr Alan Bates, i believe a number of Senators think this is a good way to start. Bates certainly made clear he does not believe the exchange is where real savings will happen; that will be in changing how people use health care (being healthy, the direction Kitz wants to go) and in getting all people insured so we stop "insuring" people via the emergency room.

that said, i cannot see for the life of me the value of blocking the exchange from negotiating. maybe it's beyond the scope of what's reasonable, given the number of plans to be included, but a, they expect citizens to wade thru that crap and 2, why say No before it's even been tried?

hooray for Susan Bonamici & Jackie Dingfelder standing up for consumers.

This is a wonderful bunch of info on the ins exchange. It starts to bring me up to speed on the subject. I have extensive experience lobbying individual representatives and senators as a private citizen on HB2009 and HB 2116. If any such lobbying is needed on this matter, I can be available.

I am very concerned about a board which is not clearly empowered to negotiate costs. I think we've had quite enough compromise with ins industry, though I understand how they might be able to either help get things going, or log-jam them. 503-622-0162

I think it's telling that the insurance companies are happy with this deal, but OSPIRG, AARP, several unions, the Main Street Alliance and many other small businesses and organizations are not.

That's a red flag if there ever was one.

"If designed well, Oregon’s Health Insurance Exchange could improve choices for quality affordable coverage."

This is an assumption OSPIRG & AARP apparently share with Mike Bonetto & is just as wrong here as there. The goals of "quality coverage"and "affordable coverage" in a private insurance market in the U.S. health system as currently constituted conflict. "Affordability" of coverage is achieved by reducing quality -- by limiting practices, procedures, or treatments covered, by raising deductibles astronomically, by making high co-pays or high percentage co-insurance. Nothing in the SB 99 exchange or the federal PPACA law stops that except whatever minimum "essential benefits" are defined, and creating affordability in premiums by raising other consumer costs (deductibles, co-pays, co-insurance) is explicitly encouraged and planned for. So negotiating premiums has limited effect.

The exchange under PPACA is a market, not an entity forming organized risk pools. It would have to be something like the latter to have the kind of negotiating power OSPIRG and AARP want -- but that would take getting federal waivers that a) aren't available until 2017 while Oregon is required to have an exchange by 2014 and b) would require federal approval it might or might not get.

SB 99 as passed without negotiating power is exactly what PPACA contemplates, a market that individuals and individual small businesses enter separately, with the theory that insurers will benefit from attracting more of them and thus will compete on price and terms to get them & their PPACA subsidies. If adverse selection cherry-picking is addressed it is through risk-adjustment that can be gamed.

Exchanges do nothing at all to address underlying reasons why private insurance and health care costs are rising so fast, and may make the administrative cost piece worse.

The governance point is a good one, and in addition to what is stated, allowing insurers in as part of the "health care sector" crowds out actual providers insofar as insurance reps are appointed to the two seats reserved for that "sector."

Even if OSPIRG, AARP and allies get what they want from the House and the Senate agrees, and even if they got a public plan included in the exchange, which apparently has gone completely by the boards, none of that would solve the fundamental and irremediable flaws of the exchange concept, based as it is on expanding our health- and cost-inefficient, unsustainable private insurance methods of financing health care.

What we really need is a universal risk pool: comprehensive benefits under a tax-funded public Improved Medicare for All (or state level equivalent) single payer plan.

I do not understand the purpose of state exchanges under the federal reform act. I know that if states don't adopt their own exchange they will be included in the federal exchange program, but I don't understand why it is bad for consumers to be included in the federal program. I get it that progressive states will create exchanges that offer enhanced coverage for women's health care, reproductive medicine, mental health issues, etc. But from the standpoint of "Joe Sixpack" looking for cheap medical insurance for his wife and kids, why is an Oregon (or Washington) exchange beneficial?

Sorry if I am being stupid, but I really don't get it.