Akhter said the business community has been unable to propose a workable alternative that would maintain the viability of the individual-insurance exchange. Among the board’s concerns, he said, was that employers with healthier workforces would tend to opt for non-exchange plans offering lower rates, threatening the viability of exchange-sold plans — so-called “adverse selection.”
“I have been asking the same question of every business leader I have had the opportunity to meet with: ‘Tell me an innovative way to make this work,’ ” Akhter said. “I haven’t gotten the answer. If it was simple, we would have made the decision in our first week.”
Turner said her group has proposed a compromise, allowing small employers to purchase outside the exchange but requiring insurers to merge the risk pools of their plans regardless of how they are sold. But Kevin Lucia, a Georgetown University professor who sits on the exchange authority’s board, said that arrangement would do little to help hold down insurance costs.
“Unless we consolidate these markets and we put them in one vehicle, we are forever going to be in a condition where we cannot start to look at the cost drivers,” he said.
Business critics did win a concession Wednesday when the authority voted to limit the exchange mandate to plans with 50 or fewer members rather than 100 or fewer members. But under the health-care law, the higher threshold will kick in regardless in 2016.
The exchange is set to open in 2014, when the federal exchange mandate begins. It is unclear what steps remain. Akhter said the board’s recommendation will be sent to White, who is tasked with implementing the exchange mandate. That could include seeking legislative action by the D.C. Council, meaning the debate could shift to the political arena.
Whether that will be necessary remains uncertain. “If I need their approval for something, I will ask the council,” White said Thursday.
Regardless, Turner said, the small-business coalition intends to lobby council members vigorously.
Akhter said he plans to move forward swiftly — even if the federal health overhaul is gutted, as presidential candidate Mitt Romney has pledged to do. “We’ve been given the funds to carry this out; we have the legislative authority,” Akhter said. “We’re going to go ahead and fulfill our duties.”