Implementation of the Affordable Care Act: Issues and Lessons from the Netherlands and Switzerland

4:00 pm on Tuesday, February 19, 2013
5:30 pm on Tuesday, February 19, 2013
Contact Name:
Jeremy Meltzer
To date, twenty-five states and the District of Columbia have announced plans to implement their own health insurance exchanges or partner with the federal government to create partnership exchanges. The issues with implementation confronting each state include: how to encourage competition among insurers in the exchanges, how the exchanges will interact with each state’s existing insurance markets, how to risk-adjust payments to insurers that participate in the exchanges and enroll people likely to have high medical expenses, and how to minimize gaps in coverage and transitions between Medicaid and subsidized insurance plans in the exchanges when people have family size or income changes. I discuss the difficulties surrounding each of these decisions and the pros and cons of options for addressing each. I also discuss some lessons from the experiences of the Netherlands and Switzerland, who had respective health reforms in 2006 and 1996, that created health insurance markets with private health insurance; the Dutch and Swiss reforms have some similarities to the US exchanges.