Wanted: Chief Operating Officer for the Connecticut Insurance Exchange Board, with responsibility for executing the strategic mission of the board established under federal health care reform and charged with creating a fair, competitive marketplace for consumers who will be required to buy health insurance by 2014.

The question for stakeholders, as we find our way in what is new health care policy territory, what kind of experience should this CEO have? With a board already dominated by insurance industry interests, it only makes sense that this executive should understand the needs of consumers.

For months, since the makeup of the Exchange Board was announced, the governor and legislative leaders who made the appointments have been under criticism for including three members whose sole work experience was in the health insurance industry, and not one consumer advocate. The membership is particularly troubling given the strong conflict of interest language that was included in the state law establishing the exchange last spring.

Connecticut’s insurance industry has long had a powerful influence over public policy to benefit their bottom line, leaving consumers unprotected. Created under national health reform, state insurance exchanges are meant to counter this advantage. It is estimated that one in ten state residents will purchase their coverage through the exchange – a lucrative new business opportunity for insurance companies.

The CEO will have a critically important position, that will include setting the standards health plans will have to meet to participate in the exchange, how much they can charge, what benefits they will have to offer, and holding them accountable to the consumers and small businesses who pay the bills.

This is a new concept for our state government, which is not used to holding insurers accountable. Unfortunately, the Board members’ biases show in the CEO job description. First in the list of qualifying experience is 5 years or more experience in health insurance. That’s not what we need.

Some argue it is important to know the insurance industry to effectively hold it accountable. But input from the insurance industry in setting public policy has never been lacking in Connecticut. If the insurance industry had succeeded in providing decent, affordable coverage, we wouldn’t need reform.

Indeed, the very notion of putting an insurance industry person in charge of implementing a health care reform panel seems to guarantee that consumers won’t be heard.  Would we have put the former CEO of CL&P in charge of the panel that evaluated response to the hurricane and snow storm that battered Connecticut last year?

There are plenty of smart, talented people in our state, with a deep understanding of the challenges facing consumers and small businesses, eminently qualified to run the exchange, who have never worked in the insurance industry. 

The Insurance Exchange Board needs a CEO with consumer experience, a leader they will trust. As a consumer advocate, I talk with uninsured and underinsured people every day. One uninsured woman I spoke with recently who works out at my gym highlighted the most important challenge facing the exchange – building public trust.

The health insurance she’s had “never covered anything I needed” and “wasn’t worth it.” She listened politely when I described the promise of the new insurance exchange, skeptical that it would be useful to her. But when told the exchange Board is run by former insurance executives, she said “Of course it is.”

To be successful the exchange CEO doesn’t need to understand insurance. He or she needs to understand the woman at my gym.

Ellen Andrews is the executive director of the CT Health Policy Project

Ellen Andrews, Ph.D., is the executive director of the CT Health Policy Project. Follow her on Twitter@CTHealthNotes.

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