As has been covered in detail by the Mirror (“As exchange board begins work, advocates still seeking change,” Nov. 3, 2011), consumer advocates are concerned that there is not a voting member on the board developing the state’s health insurance exchange who represents consumers.  Many members of the board dispute that, claiming that they represent the interests of consumers–a position that only serves to demonstrate the experience-gap of the exchange board members who have commented on this issue.

I am one of the advocates who feels very strongly that something must be done to change the composition of the exchange board if it is to represent the interests of consumers, as is the intent of the federal law as set forth in the preamble to the federal regulations.  The preamble states that “Exchanges are intended to support consumers, including small businesses, and as such, the majority of the voting members of governing boards should be individuals who represent their interests. We propose… that the voting members of an Exchange governing board represent consumer interests by ensuring that membership may not consist of a majority of representatives of health insurance issuers, agents, or brokers, or any other individual licensed to sell health insurance.”

Technically, the exchange board is in compliance with the law in that nobody on the exchange board currently serves as an employee of an insurance company.  One member, Mickey Herbert, is on the Board of an organization that consults with Assurant, so it is possible that his appointment violates state law, which bars insurance industry consultants as well as employees.

But as exchange board members and their appointers claim that they represent consumer interests and advocates dispute that claim, the real issue is that not everybody who sympathizes with or even supports the interests of consumers is a consumer representative.

I spend all day every day talking to and working for patients with chronic illnesses.  I talk to people who are trying to find insurance, so I have first-hand accounts of the obstacles patients face in attempting to buy insurance.  I represent consumers in insurance appeals, so I have first-hand accounts of the obstacles patients face in attempting to access health care even if they have insurance.  I don’t just have some generalized knowledge of, and concern for, the interests of consumers; it is my job to provide assistance to consumers in the context of health insurance.  What I see first-hand on a daily basis allows me to predict what the needs of patients will be as they seek to purchase insurance through the exchange.

The Office of the Healthcare Advocate also does this kind of work, but the Healthcare Advocate, Vicki Veltri, is on the exchange board as a non-voting member.  Not one voting member of the board of the exchange has seen what I see daily, has attempted to assist consumers to overcome obstacles to access to insurance and health care.  Thus, none of them has the experience they need to inform decisions about the structure of the exchange to ensure that the exchange will support consumers, as federal law requires.

It is critical that the exchange board understand the experience of consumers so that they can address those obstacles in creating Connecticut’s exchange.  Only by including voting members who actually work with and represent patients can the exchange board anticipate the problems consumers will face when approaching the exchange.  It’s not enough to have good intentions; without real world experience working with consumers, the exchange board members will not anticipate and address consumers’ needs.  The voting members of the board of Connecticut’s exchange do not have such real world experience.  The General Assembly, the Governor, and the exchange board itself must work to address this deficiency.

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