Members of Congress created the Patient Protection and Affordable Care Act (PPACA) public exchange system partly because they hoped setting up a Travelocity for health insurance would be a great way to cut distribution costs.
In the real world, public exchange managers are finding that setting up and running a health insurance exchange takes a considerable amount of time and money.
The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) — the HHS arm in charge of the HHS-run exchanges — release little information about how their exchanges work, but the boards of many state-based exchanges include detailed operational reports in meeting documents.
In some cases, the challenges the exchange runners face may be due to the difficulties involved with getting any big, complicated, controversial project off the ground, but, in some cases, the challenges may be due to what agents and brokers were saying all along: That servicing health plan enrollees is more complicated than servicing consumers who buy airline tickets from Travelocity.
Here’s a look at some of what the exchange runners have been talking about in recent board meeting documents.
1. Exchange QHP users may be shopping more than exchange managers had originally expected, and asking more questions
Federal and state program managers have seesawed back and forth between wanting to auto-enroll as many 2014 exchange qualified health plan (QHP) users, to make sure people keep their coverage and reduce wear-and-tear on exchange systems and workers, and wanting to encourage QHP users to shop as much as possible, to maximize the power of exchange systems to improve the quality of coverage and cut the cost.