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On the Third Hand: Success

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I wrote about the apparent lack of business at the Patient Protection and Affordable Care Act (PPACA) Small Business Health Options Program (SHOP) yesterday, and some readers had a good laugh about that program’s problems.

SHOP exchange builders were friendlier to agents and brokers than the builders of the individual exchanges were, but some of the exchange builders were downright nasty.

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On the one hand, it’s only human to take joy in rejoicing in exchange problems in beautiful, prosperous, lovely states that produce great ice cream but happen to have treated agents like dirt, or in exchange problems at a mammoth government department that has thrown sand in agent’s eyes by refusing to openly send them the e-mail newsletter sent to nonprofit navigators. Even though, actually, the agents can simply cheat, say they’re navigators, and get the newsletter anyway.

On the other hand: Joy over the downfall of meanies aside, whether PPACA as a law succeeds or fails has nothing to do with whether PPACA has succeeded or failed.

Most people have agreed for decades that the U.S. health care system is expensive, inefficient and unfair. Whether people got wonderful care or no care at all often depended on a roll of the device. 

Wildly popular provisions in PPACA that have drawn little criticism from anyone, such as provisions requiring insurers to cover basic childhood immunizations and offer a formal appeals process to enrollees affected by benefits denials, died in the cradle year after year before PPACA came along.

Meanwhile, some major parts of PPACA seem to be a complete mess. The individual public exchange system can, miraculously, help consumers who are desperate for health coverage enroll in almost-free coverage, but it seems as if a consortium of Anthem, UnitedHealth, Aetna, Humana, Health Net, Kaiser and a few big nonprofit plans and Web brokers could probably do the same job better and have money left over to send the enrollers on great incentive trips to Hawaii.

The SHOP exchange system seems to have exposed a more serious PPACA-related problem: the utter inability of the U.S. Department of Health and Human Services (HHS) and its agencies to operate in a transparent way.

On the third hand, one great thing about the lack of PPACA transparency at HHS is that it’s helped teach us how businesslike and transparent the Internal Revenue Service (IRS) is. Sometimes you need a bad cop around to show you who the good cop is.

On the fourth hand, it seems as if the glitches at the individual exchanges, and the torpor at most SHOP exchanges, have gotten creative juices flowing at private insurers and private brokers.

If the exchange system died, and insurers’ ability to figure out how to sell individual coverage on a no-medical-underwriting basis also died, that might represent a true failure. I sense no passion at any health insurers for the good old days when they had to get detailed information about applicants’ every hangnail.

If the exchange system dies, and the insurers can figure out how to keep selling individual coverage on a no-medical-underwriting basis, and private insurers and brokers can swoop in fill the void left by the disappearance of the public exchange, where’s the problem?

Sometimes you need a GEnie and a CompuServe Information Service to come along and offer a “meh” pioneering service to bring the World Wide Web to life.

If the PPACA public exchanges attract a new generation of private competitors that crowd the public exchanges out of business, by offering great products at a great price, that would represent a glorious success for PPACA.


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