One econ major. Three (or more) opinions.

My editors asked me to follow up on a great Bloomberg article about the possible effects of the Patient Protection Affordable Care Act (PPACA) employer mandate delay.

Alex Wong quoted interesting experts who suggested that the mandate delay could lead to increase in enrollment at the individual health insurance exchanges.

If, for example, PPACA gives employers no shove to expand group health enrollment in 2014, and the states and the Obama administration manage to get the individual exchange program and the PPACA individual health insurance purchase tax credit subsidy program more or less as written, more or less on time: Then, the workers who still don’t have affordable health care will have an incentive to run on over to the exchanges to buy coverage there.

Meanwhile, the Republicans seem to be doing their best to strangle U.S. Department of Heath and Human Services (HHS) exchange marketing program, by leaving it about enough cash to pay a few guys in frowzy Elmos suit to hand out a few exchange postcards to tourists in New York’s Times Square. (“Bring three paying guests to the exchange and get a mixed drink for free!”)

It hit me that the combination of more business from middle-income workers and less business from low-income people who are hard to reach because they live under highway overpasses might be good for the exchanges.

On the one hand, one challenge is that, no matter who signs up for exchange health coverage, patients who already have one foot in the grave are sure to take advantage of the PPACA requirement that health insurers make coverage available even to people with serious health problems.

That will push claims costs up.

But, on the other hand, going by the look of the panhandlers in my area, the uninsured people who live under overpasses probably have a lot of unmet needs for medical services, ranging from high blood pressure to uncontrolled diabetes to life-threatening cirrhosis of the liver, and exchanges may not have much luck with using their limited budgets to reach those folks.

The workers without group health insurance may be healthy enough to work, and maybe quite a few of them are people who were healthy enough to choose jobs with higher pay over jobs with richer benefits. Maybe insuring them will help moderate the exchanges’ claims costs.

On the third hand, you never know. Love PPACA or hate it, the story of PPACA has been pretty suspenseful so far, and it may yet find more ways to take amazing and unexpected hairpin turns.

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