Despite all the noise attendant upon health care reform, a staggering number of Americans still claim not to know how the Affordable Care Act of 2010 is going to affect them. Ask most what they think of the health insurance exchanges that are, arguably, the centerpiece of the Act, and even if they live in Utah or Massachusetts, where exchanges are already operating, most are hard-pressed to describe what they think these exchanges are — and will hope you can enlighten them. Rare is the individual who can discuss the myriad issues surrounding exchanges, and it’s hard to imagine that this is not the case even among many who work in the insurance industry. (Hint: I find it helps to compare them to Travelocity, at least in theory.)
But given the predictions on participation over the next decade, you just know there are bound to be thorny issues. I sat down the other day and quickly brainstormed a list of some of the major issues that are at play as states begin to grapple with constructing their own exchanges – or wait for the federal government (perhaps even the Supreme Court) to handle it for them.
Having followed the health reform debate since the 2008 Presidential campaign, it wasn’t hard to put this list of questions together. (Please note I didn’t say the “answers.”) Of course, the list I created is fairly high-level –- volumes could be written reciting the litany of concerns, complaints, fears, misunderstandings, and questions not just from within the insurance industry and government at all levels, but out in the homes and workplaces and coffee shops and centers of learning throughout this country and beyond. How this evolves is being watched, probably even from space!
So here’s the quickie list I assembled:
- How many states will meet the deadlines for open enrollment (October 1, 2013) and implementation (January 1, 2014)? At least 15 states have gotten things started, with a number of others moving in that direction. Some however, have made no moves to establish an exchange, and some, as I’ve written recently, may be holding out hopes of avoiding implementation via compacts.
- Which operating model(s) will states use? Different states have different needs; for example, Utah and Massachusetts. What will play in Peoria may not play in Portland.
- What will health plans offer through the exchanges? Minimum benefit requirements have not even been established at federal level yet.
- Regional exchanges – what will their impact be?
- Will individuals and small employers be satisfied with the offerings available to them? Will the exchange offerings be easy to understand, and affordable?
- What are the governance issues? What new regulatory compliance demands will be placed on states and insurers relative to the exchanges? What role will exchanges play in rate review processes? Upon what criteria will the admission of insurers and plans to the exchanges be based?
- What will the costs of operation of and participation in exchanges be, and how will they be financed?
- What technical resources will be needed to establish and operate exchanges?
- How will producers be involved? How will they be affected?
- Actuarial issues such as product design, potential for adverse selection, meeting MLR requirements
- How will insurers’ bottom lines be affected?
- Shift from group plans to growth in individual plans; Potential for large employers to participate – implications
- Employer/employee issues: effects on employer-sponsored health care benefits, recruitment and retention of staff
- By what metrics can success be measured, and when?
- What effect would a Supreme Court decision overturning all or part of the Affordable Care Act have?
Even if these were the only issues, which of course is not the case, the prospect of the major overhaul of the health care system in the US would be daunting. But as I like to think of it, this is why the gods created the Internet, which is an invaluable source of information and insight for those of us who struggle to stay on top of this many-layered onion that keeps being peeled back, ever so slowly it sometimes seems.
It’s a little late for your summer vacation reading list, but here are some excellent and often thought-provoking articles and reports that may help shed light or, at least, expand perspectives, on these and other issues:
SHOPping Around: Setting up State Health Care Exchanges for Small Businesses: A Roadmap – I learned of this article out at ProducersWeb.
PricewaterhouseCoopers’ Health Industries practice area has some excellent articles, such as Change the channel: Health insurance exchanges expand choice and competition and Health Reform: Prospering in a post-reform world.
At Deloitte’s Health Reform Insights area, check out articles on exchanges such as Health Insurance Exchanges: A strategic perspective, and Health Insurance Exchanges: Strategic questions for health plans.
McKinsey recently drew quite a lot of attention from both sides of the health reform debate with its report on How US health care reform will affect employee benefits.
The Georgetown University Health Policy Institute has an interesting paper comparing and contrasting the Massachusetts and Utah Exchanges: Lessons Learned and another looking at Active Purchasing for Health Insurance Exchanges: An Analysis of Options.
The Commonwealth Fund has articles on exchanges and other reform-related topics. Recent ones include State Health Insurance Exchange Legislation: A Progress Report, which includes a State Exchanges Map, Reality Check: Defining Expectations for the State Health Insurance Exchanges, HHS’s Proposed Regulation for Health Insurance Exchanges: An Emphasis on State Flexibility Part I and Part II.
Knowledge@Wharton looks at The Connector in As Goes Massachusetts, So Goes the Nation? How Reform Is Impacting Health Care in the Bay State. Also, check out Robert Wood Johnson Foundation’s Risa Lavizzo-Mourey: The Challenges Facing Health Care Reform.
Milliman has briefing papers and videos examining The Impact Of Healthplan Benefit Changes On Cost And Utilization, the Top 10 Actuarial Issues For A Health Exchange, Health Insurance CO-OPs: Challenges and Opportunities, Designing Health Exchanges State By State, Key Considerations For Health Exchanges, and more.
Over at Towers Watson, there’s a bulletin on the HHS Proposed Regulations on Health Insurance Exchanges issued last month. In addition, the way health reform may play out in the workplace is examined in Treating Our Ills and Killing Our Prospects and Employee Engagement and the Transformation of the Health Care Industry.
The National Conference of State Legislatures is a great site for news and analysis on implementation of health reform in general and exchanges in particular.
Recent interesting exchanges-related articles:
Schumpeter, July 26, 2011. Business and health-care reform: Unfortunate side-effects. The Economist.
Schumpeter, July 14, 2011. Health-care reform: Competition or Chaos? The Economist.
Allison Bell, April 18, 2011. Researchers: Getting Brokers Angry May Slow Exchange Growth. National Underwriter.
Allison Bell, July 11, 2011. Producers: HHS Exchange Builders Love Ya, Baby. National Underwriter.
NU Online News Service, July 18, 2011. Moody’s: Exchange Rules Bad for Insurers. National Underwriter.
Pat Speer, July 20, 2011. Questions Plague State Health Exchange Program. Insurance Networking News.
Sam Baker, July 27, 2011. Lack of State Exchange Laws Squeezes Planning Effort, Officials Say. Insurance Networking News.
Editor’s Recommendation: NILS INsource can help keep you current with PPACA and healthcare reform initiatives.
The “Affordable Care Act of 2010″ will not be affordable at all. The enactors were caught up in campaign sound bites touting guaranteed coverage, kids insured until they’re 28, pre-existing condition coverage. The dollars and cents of the program, however, don’t make sense. Employers will weight cost/benefit: $6,000 to insure an employee or $2,000 penalty. No brainer. Employers will cease offering the benefit, upending an entire insurance industry, employer-employee relationships and health care coverage as we know it. Employees who pay a fraction of the premium, if anything, with their employer offered plans will be thrown out into the individual insurance marketplace at a higher premium thus reducing their expendable income (if they can afford to buy the coverage at all). An if they don’t buy it, the feds want to throw them in jail. We don’t have enough jail space let alone the budget to feed that many people who can’t afford to individually purchase the coverage This Act needs to be repealed and/or declared unconstitutional, but it has to go.