August 7, 2012 - Wall Street Journal
Puzzling Over What to Call State Insurance Exchanges
Health-insurance exchanges are a central part of the Obama
administration's health overhaul, serving as marketplaces for people to shop for
coverage. But states trying to set them up are finding many people don't know what
an exchange is and don't necessarily like the sound of it.
As many as 25 million people are supposed to gain coverage through the
exchanges over the next decade, according to the latest Congressional Budget
Office estimate. States can run the exchanges themselves, or if they refuse to do
so—an option many states hostile to the law are considering—the
federal government will do it for them.
The exchange will be the main place to turn for those who lack coverage through
their job and aren't eligible for Medicare or Medicaid. Consumers will be able to
go online and choose between a range of health plans from private insurers that
meet minimum coverage standards, while lower-income Americans can apply for tax
subsidies toward the cost of premiums.
Only 13 states have committed to running their own exchanges. They have boards
and agencies grappling with updating computer systems and state insurance rules,
but officials say one of the biggest concerns is persuading people to use the
system once it is set up.
States have hired consultants to help with the branding and are learning that
many consumers are wary of insurance.
Focus groups in Oregon expressed emotions about buying coverage that included
"skepticism" and "frustration," and some individuals and small businesses used
"black hole" and other less-kind terms to refer to insurance, brand design firm
Sandstrom Partners told the Oregon Health Insurance Exchange in a presentation
made available by the exchange.
The word exchange "raises some suspicions of loopholes and fine print" and
"implies current coverage may needed to be traded for something else," wrote
communications company GMMB in a presentation to the Washington State Health
Benefit Exchange. Part of the problem, GMMB said, was that the word was "perceived
as a verb and unfamiliar as a noun" and reminded people of the New York Stock
Exchange or military exchange stores.
The states are weighing alternatives.Many states use their own names for
federal-state programs, such as Medi-Cal, which is California's version of the
Medicaid program.
Washington state is leaning toward calling its program Washington HealthLink,
as long as it doesn't conflict with existing trademarks, and plans to use green
and blue in its logo design because the colors are considered to be reassuring,
said Michael Marchand, the state's exchange director. The exchange's board of
directors will make the final decision on the name, he said.
Focus group participants had also been asked to consider HealthChoice but it
"makes some wonder if Washington State is making the choice for them," consultants
and the exchange board concluded.
In Minnesota, Health Choices was popular with consumers
and businesses, but some focus-group participants found it "wishy-washy, not as
classy," consultants Salter Mitchell told the state in late July. Another option,
Minnesota Health Insurance Marketplace, "sounds more professional" but "doesn't
sound like government at all," the focus groups told the consultants.
The federal Department of Health and Human Services has said that states have
plenty of leeway in running exchanges, and that extends to picking the name.
Kathleen Sebelius, the HHS secretary, has often described the exchanges as
"marketplaces" in her speeches.
Massachusetts, which in 2006 adopted a system similar to the subsequent federal
overhaul, calls its exchange a "health connector."
At least one state says it doesn't have a problem. "We don't look at 'exchange'
as a dirty word," said Kevin Counihan, head of Connecticut's exchange. Because of
the stock exchange in neighboring New York, he said, "it conjures up something
that people recognize."
Write to Louise Radnofsky at louise.radnofsky@wsj.com