As the one-year anniversary of the signing of the Affordable Care Act approaches, the political rhetoric against the health law remains as heated as ever. But as more and more Americans experience the benefits of the law on their everyday lives, a growing number of stakeholders in the states - including health insurers - are coming out in support of both the law and its effective implementation in the states. Successful implementation requires states to enact their own exchanges, or marketplaces for health insurance, as the vehicle that provides for quality, affordable health insurance coverage.
In Vermont, the president of the state’s Blue Cross Blue Shield, Don George, had words of praise  for the single-payer health reform proposal currently under consideration in the state legislature. The Vermont reform, among the most progressive in the nation, would be allowed to take effect sooner than under the provisions of ACA due to a proposed waiver supported by the White House. In stating that his company needed to look at their changing role in the health care debate and voicing concern about becoming a casualty of the law, his remarks were a reminder that, contrary to right-wing rhetoric, the health care law does not threaten the existence of the private health insurance system. George claims the goal of health reform should be “a transformed health care system in which every Vermonter has health care coverage and receives timely, effective, affordable care.”
Meanwhile, in Minnesota, Blue Cross Blue Shield has partnered  with Fairview Health Services to try out new approaches to health care delivery and insurer payment. A model is in place that increases payments to doctors for good outcomes with patients rather than a fee for service. In light of the politics surrounding repeal, CEOs of both Minnesota companies presented the model to America’s Health Insurance Plans (AHIP), both agreeing that the current system is broken and can’t provide adequate, affordable coverage to all Americans without changes. The CEO  of the Blue Cross Blue Shield of Minnesota even went so far as to say that “we’re tired of defending a broken health care system.”
As insurance companies in the states indicate their support for the health law, a recent report  notes that “dozens of health provider groups, advocates for people with disabilities and illnesses, hospital associations, health economists and other groups” have filed amicus briefs opposing the court challenge against the health law. One of the states filing a brief was Massachusetts, stating that their law, which was signed by a Republican governor, reduced state costs on on “free care” for uninsured and under-insured, from $709.5 million to $414 million, by covering more than 95% of the state’s residents. Massachusetts has the lowest rate of uninsured in the country.
As the AP reported  this week, not only is legislation to expand coverage and crack down on industry abuses moving quickly in states like Connecticut, Oregon, and Maryland, but four states with new conservative leadership have received grants to build software infrastructure for the online insurance marketplaces at the heart of the health care law.
The need to change how we do business in health care coverage must change - a call echoed in conservative states and by insurance company leaders alike. These leaders recognize that efforts at repeal will fail unless we rein in cost, increase competition and expand affordable and quality coverage.
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Burlington Free Press (VT) - Blue Cross willing to adapt to changing health insurance environment 
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