The Consumers’ Choice Health Plan “is a private, nonprofit, market-based solution, locally-based solution,” he said.
It is one of 24 state-based Consumer Operated and Oriented Plan nonprofits that got federal loans under the Affordable Care Act to establish themselves as affordable options once health insurance marketplaces begin enrollment Oct. 1. The CO-OPs, as they are called, essentially replaced the public option that advocates originally wanted to compete with private insurance companies but that conservatives derided as a back-door to creating a single-payer, government-run health system.
Burgess helped found and was running two business coalitions, The South Carolina Business Coalition on Health and the Tennessee Health Care 21 Business Coalition, when they began looking at the possibility of a health insurance cooperative three or four years ago, before the health care overhaul passed, he said. He helped lead a coalition of groups that made a bid for a CO-OP in Tennessee and in South Carolina, and both applications were successful. The group got an $87.6 million loan to establish the Consumers’ Choice plan in South Carolina.
A coalition in Georgia was among the 44 applications from 26 other states that were shelved when funding for the program was sacrificed during the "fiscal cliff" negotiations. But that fight isn’t over. Many of those groups are banding together in a grassroots lobbying effort to try to get Congress to pass funding to restore the loan program, said Terry Shilling, the CEO of Beam Partners, who helped establish CO-OPs in Kentucky and Louisiana and was helping to lead Georgia’s application.
“We’re working on that right now,” he said. Without a CO-OP, Shilling said, Georgia “won’t have a local nonprofit, member-governed alternative. The vast majority of the plans of all types here in Georgia are corporately owned, often with headquarters somewhere other than the state. We wouldn’t have had a focus on anything other than Georgia. And clearly, with the uninsured issues the state has, we think we would have been a welcome alternative to some of these national players. We would have been able to do things in a purely Georgia way.”
It’s hard to know before the marketplaces even start what the lack of a CO-OP will mean, said Cindy Zeldin, the executive director of Georgia for a Healthy Future.
“I think there was hope that they could help create more competition and help keep prices down in the exchange,” she said. “Without that, it’s hard to say. The marketplaces haven’t come on line yet and we’re still hoping that they will work well and the insurance carriers will all come onto them and that there will be competition.”
One selling point Consumers’ Choice will offer new policy holders is that people like them actually make up the board of directors, Burgess said.
“If your board of directors is average people, what do they think about holding down the cost of their premium?” he said. “It’s their No. 1 priority.”
Burgess doubts other insurance company boards are made up in a similar way or have the same priority as his board will have.
“I’m talking about people who, if you raise your premium $100 a month, they can’t afford it,” he said. “That’s our board of directors. Leadership matters.”
In less than seven months, the company will begin its offerings in the exchange and Burgess said it is well-prepared, having hired experienced people, opening offices in Charleston and Greenville and now with outreach to every county in the state. They are building their provider network and plan to have everything in place by July 1.
The company is planning to do a lot of community outreach to help educate people about its offerings and how the system will work, Burgess said.
“We’re going to have a face-to-face, high-touch way of dealing with people,” he said. “We’ll be talking to churches and we’ll be talking in barbershops and we’ll be holding townhall meetings. Every time we can get four or five people together we’ll be talking to them. I’ve got people already touching every single county in South Carolina.”
Still, based on previous launches of far-reaching health care changes, such as Medicare Part D and the health insurance exchange in Massachusetts, Burgess doesn’t expect smooth sailing for anyone at the beginning,
“I’m sure we’re going to hit rough spots,” Burgess said. “It is going to be difficult. It is going to be chaotic. But if you think about great social changes that occur in society, they are always sort of through an evolutionary process. And this will be an evolution.”