But they should provide more flexibility for consumers and reduce administrative burdens on small employers, Mississippi Insurance Commissioner Mike Chaney told participants in the annual Managed Care Conference on Thursday.
"It presents a host of challenges," Chaney said, and there are no guarantees about how well it will work. "This is probably one of the best solutions we've got."
The basic idea is to let individuals shop for health insurance much the same way they can shop for airline fares - with side-by-side comparisons on costs and coverage, Chaney said. Participation in exchanges is completely voluntary.
Small employers will have the option to set a defined benefit - how much they want to contribute toward insurance premiums. Employees get to choose what policies work best for them, and if they want to pay more money for more coverage.
The Mississippi Insurance Department is modeling the exchange after Utah's health exchange, which began in January 2010 with 11 small employer groups and now has more than 150 groups covering more than 4,000 people.
Chaney sees a key role for insurance agents and brokers who will provide key expertise to individuals as navigators in the insurance system.
Under the law, the health insurance exchange will initially be focused on employees of small companies and those who qualify for government subsidies to pay for health care, but the exchange eventually will be expanded to others.