The Insurance Marketplaces

By Author: Marcus Stalder
Total Articles: 491
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Like everything written down, the Affordable Care Act sounds the perfect answer to all our problems. Except, of course, when it comes to turning the words into action, problems can emerge. One of the battlegrounds is turning out to be the insurance marketplaces or exchanges. These are supposed to make it easier and cheaper to buy insurance. They should allow people to compare prices, and discover whether they are entitled to any assistance like tax credits, Medicaid or the Children's Health Insurance Program (CHIP). Every state is supposed to have one up and running by 2014. Should any state default, the federal government is apparently ready to step in and run one. The principle matches the mandate. If everyone is required to buy a policy, buying a policy should be made as easy as possible.

As we come in the Fall, ten states have already passed the necessary enabling legislation and are on their way toward getting their exchanges in place. Seven more states have bills pending. Legislation has failed in sixteen states. The rest of the states have either decided to take their time or are flatly refusing to make progress. ...
... Such is the world of politics with the Republican party dead-set against exchanges. Some GOP governors have sworn oaths on a stack of Bibles they will never sign an enabling bill into law. Yet this is not necessarily good politics.

Because the federal government will impose an exchange if the state refuses to act, the arrival of an exchange is unavoidable. Some GOP governors are therefore interested in negotiating terms. If they have no choice, they might as well try to influence the outcome to their advantage. So this September, health officials from the majority of the states will be attending a conference organized by the Department of Health and Human Services. Most GOP governors are prepared to talk about a partnership approach to give them some political leverage. Equally, if the states actually do less of the work, the budget requirements will be lower. For example, some states are offering to run local call centers to guide people through their choices. This is fairly uncontroversial. More problematic are the offers of some states to run outreach and education programs to bring their citizens into the exchanges. If staff hostile to the notion of the exchanges are involved, the exchanges may not get the expected number of applicants.

When the dust settles at the end of all the negotiations, we can hope for a health insurance exchange or marketplace in every state where citizens can be guided between federal and state aid, and the private section plans. With supportive staff working in the call centers, everyone should end up with the level of cover appropriate to their individual needs. Significantly, the exchanges are also intended to help small and medium-sized businesses navigate the new laws. Many business people are as confused as ordinary citizens. If everything works as it should, we should all find access to affordable covered significantly easier. However, with their opposition to the central principles of Obamacare undiminished, we can expect the GOP to find a whole new set of ways to slow down this health insurance reform. Your vote in the next election will help decide matters.