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Summer reading: Exchange Games

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America’s Health Insurance Plans, the National Association of Health Underwriters and other health and benefits groups are getting ready to hold their last big annual meetings before Jan. 1, 2014.

Hundreds of agents, brokers, consultants, actuaries, strategic planners and other local fonts of PPACA wisdom will be heading to the meetings in an effort to get information they can use to protect just how the major Patient Protection and Affordable Care Act (PPACA) exchange and private health insurance provisions will or won’t affect health carriers, producers, benefit plan managers, employers, consumers, patients, physicians, hospitals, advertising agencies, makers of novelty keychains, and others.

Accenture and Truven Health Analytics are two examples of companies that have released PPACA exchange forecasts in time for the summer conference prep season.

Suzanne Collins hooked readers of The Hunger Games series with tales of a gladiatorial-style reality TV show set in the distant future.

Accenture analysts are hoping to hook health policy readers with tales of a gladiatorial-style contest — the birth of the PPACA exchanges — start about seven months from now.

The analysts note that employer plans cover 170 million people today.

In 2014, about 9 million of those people could get coverage through a PPACA group coverage exchange, and 1 million could get coverage through a private group coverage exchange, the analysts estimate.

By 2018, public group exchange enrollment could climb to 31 million lives, and private group exchange enrollment could grow to 40 million lives, the analysts say.

One reason to think that growth could be rapid is consumers’ lack of awareness of the private exchange model, the analysts say.

“Once presented with the concept, 85 percent of those surveyed expressed a neutral to positive outlook,” the analysts say. “Respondents are attracted to choice, flexibility, the personalized product selection, and the shopping experience.”

Three analysts at Truven are looking at what the PPACA changes might do to claims.

Some PPACA advocates say PPACA won’t have much effect on costs, because uninsured people tend to use much less care than others, are generally healthy, and will become even healthier once they have steady access to preventive care and help with keeping small problems small, the Truven analysts say.

“Future Medicaid eligibles appear to be somewhat healthier than current Medicaid enrollees, while future exchange likely adults appear to be somewhat less healthy,” the analysts say. “Yet both newly eligible groups use services at much lower rates than currently enrolled adults. In addition, we found that at least half of future eligible adults had been without coverage for significant periods of time.”

Most of the uninsured people do think they need health insurance, the analysts say.

“This suggests that the newly eligible may have deferred care or may have health issues that have been undiagnosed due in part to low rates of encounters with medical professionals,” the analysts say.

Some who think the exchange population will be especially healthy are probably overstating any advantage exchange plans will have over ordinary Medicaid plans, the analysts said.

In other PPACA reading material news:

Mercer’s Washington Resource Group has come up with a list of the top 10 employer PPACA tasks for 2013. The first is “Decide whether to ‘play’ (provide employer-sponsored coverage meeting certain standards to full-time employees) or ‘pay’ employer shared-responsibility penalties.” pointed out that 64 percent of the 286 uninsured Americans who partcipated in a recent survey it sponsored are still not sure whether they will somehow get health insurance in 2014 or end up paying the $95 tax to be imposed on consumers who fail to meet PPACA minimum coverage standards. 

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