While we wait for Federal District Judge Henry Hudson to rule on Virginia’s challenge to ObamaCare, here are some thoughts on health care exchanges.

Checks have started to
arrive from Blue Cross Blue Shield to compensate subscribers for the likely
loss of their insurance policies in 2014. These checks may build goodwill for
now, but it may not carry over when people lose their policies in a couple

Regardless, Gov. Perdue and Insurance Commissioner Wayne Goodwin are committed
to imposing a health insurance exchange on North Carolinians in 2014. The
General Assembly must assert its role in the process and limit Commissioner
Goodwin’s ability to destroy competition. A first step would be to pass an
"unintended consequences" bill that requires a report on the
consequences of regulatory changes and halting any action unless it receives
affirmative action from the General Assembly.

On their own, these two moves could stop a market-destroying health insurance
exchange, but legislators (and those
working on the exchange now
) will also need to suggest what an exchange
could look like. Based on conversations with insurance and health policy
experts across the country, here are the most important features of a
market-friendly exchange. None of this means that I think there is a good
exchange, but if the state is going to create an exchange anyway, its damage
should be limited.

  1. Allow a market to continue outside the insurance exchange. If individuals
    are willing to go without the tax subsidies of the exchange, they should have
    the option. 

  2. Put the insurance exchange under an independent board like Inclusive Health, the state
    high-risk insurance pool.

  3. Allow any willing and licensed insurance company to offer plans

  4. Make the exchange an information clearinghouse without imposing new
    requirements on the types of insurance policies available.

  5. Any exchange should also have a sunset provision so the state is not stuck
    with needless bureaucracy when the federal mandate expires.

These recommendations are a third-best solution necessary because the governor
and insurance commissioner are already committed to creating a health insurance
exchange. There is no good insurance exchange, but an exchange meeting the
steps outlined here would be less bad.