Health industry consultants at PricewaterhouseCoopers have hinted at some of the difficulties national and regional commercial health insurers might face as they adapt to the world of Patient Protection and Affordable Care Act (2010) exchanges.
For health insurers, the world of the state PPACA exchange programs and the U.S. Department of Health and Human Services’ PPACA exchange program might start out looking like a benefits market chessboard.
Insurers might have to struggle to decide how much effort to put into getting into each exchange program, and when to try to get into it, the consultants say.
“Participation in all 50 public exchange markets may not be realistic—or worthwhile—for all but a few players,” the consultants say. “Insurer participation will depend on how each state exchange is run, the parameters that are set around a qualified health plan and the structure of essential health benefits, including how similar those standards are across states.”
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PPACA opponents are still trying to kill PPACA or block implementation of the law, but many health insurance industry benefits players are predicting that the PPACA exchange program will come to life in some form no matter what happens to the rest of PPACA.
The PPACA exchange provision calls for state and federal agencies to set up a system of exchanges, or Web-based health insurance supermarkets, that will help individuals and small employers use new PPACA tax credit subsidies to buy high-quality health coverage. The exchanges are supposed to be available for an open enrollment season starting in late 2013 and to make coverage available Jan. 1, 2014.
States can build their own exchanges, let the U.S. Department of Health and Human Services (HHS) provide exchanges for their residents, or share responsibility with HHS. HHS is supposed to provide exchange services for residents of states that do not provide their own exchange services programs.
States are supposed to tell HHS what they want to do about setting up, or not setting up, an exchange by Nov. 16.