The federal Affordable Care Act frames health insurance exchanges as a transparent and competitive insurance marketplace where individuals and small businesses can get the same health insurance benefits as large corporations.

On April 25th, the Oregon Senate passed SB 99, a bill, years in the making, that helps create a health insurance exchange for small businesses in Oregon. The Oregon Health Authority, under Dr. Bruce Goldberg, led public input sessions that helped craft SB 99. In its final form, the bill passed in the Oregon senate by a vote of twenty-four to five but not without controversy. The proponents of a strong exchange say SB 99 is being corrupted by insurance influence, revoking the exchange’s ability to negotiate prices with insurers and placing insurance companies in a conflict of interest on the governing board of the exchange. The insurance industry opposes an exchange that would have the power to negotiate prices, saying that this takes a large stride into the regulatory realm of the industry. At the time of writing, the bill moved to the Oregon House of Representatives where consumer advocates and insurance lobby redoubled their efforts. This debate will likely continue at least until 2014, the Affordable Care Act’s deadline for states to create competitive individual and small business health insurance exchanges.

Laura Etherton


We all know health insurance costs too much. According to a study by the Kaiser Family Foundation, the average cost of employer-sponsored family coverage will hit $27,000 per year by 2016 in Oregon.

The rising cost of health care is one reason that our state has begun working to develop a health insurance exchange that will be open for business in 2014. But whether the exchange delivers real results for people facing these rising costs depends on how well it’s designed. Right now, Oregon officials are putting together the plan.

Done right, the exchange will leverage the buying power of hundreds of thousands of Oregonians to negotiate lower costs and better quality coverage choices. Done wrong, the exchange will have the same types of high costs and spotty coverage plans we see today. To succeed, it’s critical for the people who pay the costs—consumers, business owners, and taxpayers—to be involved every step of the way.

Will the exchange be transparent and accountable? Will it have the ability to negotiate on behalf of enrollees for lower costs and better care? Will it make it easy to see which plans get the best health results for patients? Will it be user-friendly and responsive to enrollees’ needs?

The exchange has the potential to be a powerful force to level the playing field for consumers and small businesses in dealing with the big health insurance companies. But as you can imagine, those same insurance companies have quite a lot to say about how they would like to see the exchange run.

We encourage Oregon consumers and businesses to get involved with the work to develop the plan for the exchange. And we urge state officials to stand up to the health insurance companies and make sure they design an exchange that delivers real results for Oregonians.

Jared Short


As I write, Oregon’s legislature is still shaping the future of our state’s health insurance exchange. Throughout the process, Regence BlueCross BlueShield of Oregon has been engaged in the discussion because we recognize the financial stability and physical wellness of our members is at stake.

Our vision for the exchange is centered on the needs of Oregonians. Consumers, whether they are small businesses or individuals, deserve the opportunity to compare a wide range of plans against one another—apples to apples. We need to create a level playing field where shopping for complicated coverage is simplified in a transparent and competitive marketplace that allows consumers to select plans and prices that fit their needs. Oregonians deserve this, and Regence is committed to earning their business.

Oregon’s exchange should be financially self-sustaining and accountable to those who participate. If an insurer chooses to offer a plan, it must incorporate administrative costs into its fees. In reverse, plans that are not offered, shouldn’t be forced to bear the burden of a marketplace from which they can’t benefit. Finally, this exchange should be governed by a diverse board of experts who understand the complexities of the insurance industry, but who answer to the needs of an empowered pool of consumers and the exchange itself.

As a nonprofit health insurer, Regence empathizes with the financial reality facing Oregonians. In the end, we want what so many others want—affordable health care offered in a transparent and efficient marketplace that benefits individual Oregonians and small businesses. The decisions we make now will impact generations of Oregonians to come. Getting this right is critical. Regence is dedicated to the mission as we strive to improve Oregonians’ health care coverage and overall wellness.

Laura Etherton and Jared Short
OSPIRG Health Care Advocate vs. Regence BlueCross President | + posts