An exchange by any other name is still an exchange


Juliet famously remarked to her beloved Romeo, "a rose by any other name would smell as sweet." The same is true about health insurance exchanges, albeit not nearly as alluring a topic as Romeo and Juliet's ill-fated romance.

As the 13 states that have committed to implement their own exchange have been working toward that goal, many are realizing that the biggest hurdle isn't updating IT systems or determining qualified health plan criteria. The main obstacle, according to a recent Wall Street Journal article, is that people don't know what an exchange is and they don't have a favorable opinion of the word "exchange."

The word exchange "raises some suspicions of loopholes and fine print" and "implies current coverage may need to be traded for something else," communications company GMMB told the Washington State Health Benefit Exchange. People also perceived the word exchange as a verb, reminding them of the New Stock Exchange or military exchange stores.

Adding to the confusion is consumers' wariness of buying insurance in the first place. Consultants hired by the Oregon Health Insurance Exchange found that consumers are skeptical and frustrated about buying health plans. Others referred to health insurance as a "black hole." These less than stellar consumer responses don't exactly bode well for exchanges' success.

States' solution to this public image problem largely has been to avoid the word exchange altogether. Washington state, for example, said it likely will name its exchange Washington HealthLink. Meanwhile, Massachusetts, which created a state-run exchange back in 2006, calls it a "health connector."

But it seems to me that this whole name-changing approach misses the point. The problem is that consumers are wary of insurance. Period. The name of the website where they buy insurance isn't going to change that deep, underlying problem. You could name a state-run exchange "the shop for the best health coverage ever" and people would still be skeptical.

So instead of focusing on a cosmetic problem, so to speak, I urge state officials and insurance execs to continue their outreach, working to alter the negative public image of an entire industry. Although insurers aren't directly responsible or liable for the success of each health insurance exchange, they stand to reap millions of dollars from new consumers purchasing policies at these exchanges. So the ability of each exchange, marketplace, connector or whatever you want to call it to attract consumers does impact insurance companies. It's in their best interest, therefore, to help states establish a popular and thriving online marketplace.

Maybe if people feel insurance companies could be trusted, they wouldn't be so leery of shopping for and buying health plans on this new thing called an exchange. Because, really, Juliet was onto something when she asked Romeo: "What's in a name?" It's not the name itself that magically transforms an exchange into a dynamic marketplace. It's the hard work behind the scenes--for example, states that allow only quality health plans to be sold and insurers that engage in public outreach and goodwill that will determine whether exchanges can deliver on their promises.

I really hope state officials and insurance execs succeed in this endeavor. I would hate to alter Juliet's infamous words to "an exchange by any other name would smell just as rotten." That just doesn't have the same ring to it as Shakespeare's script. --Dina (@HealthPayer)