3 ways to grade the third PPACA open enrollment period

Republicans in Congress have objected loudly and often to the idea of letting a paragraph of PPACA stay in force, but the Obama administration has not bothered to float even doomed proposals to ask Congress for more exchange funding or for any other help for the exchange system. 

In some markets, the exchanges offer QHPs from many issuers. But, in many markets, the number of issuers is small enough that their top executives could get together in a small care plan.

Policymakers may start to ask whether spending the money to run a Web-based public health insurance supermarket in the hope of attracting new competitors that never arrive is a good way to use that money. 

But executives at the big, publicly traded insurers still seem to like the exchange concept. They have expressed some concern about competitors’ pricing during conference calls with securities analysts, but they’re talking about the exchanges during earnings calls. What they’re not talking about during the earnings calls is agents and brokers.

2. Can the public exchanges hold their own against the private exchanges?

It’s not clear whether some private exchanges have progressed much beyond the vaporware stage, but Towers Watson & Company (NYSE:TW) has justified the argument that private exchanges are a thing by adding “Exchange Solutions” information to its quarterly earnings releases.

The company’s exchange program is reporting $22 million in net operating income for the third quarter on $118 million in revenue, up from $14 million in net operating income on $86 million in revenue for the third quarter of 2014.

In some states, public exchanges might be able to have positive net operating income totals of their own. In other states, even public officials who like the exchange concept might start to prefer doing business with a private exchange that generates extra money to doing business with a public exchange that drinks taxpayers’ money.

See also: How private exchanges are trying to stand out 

3. Can the public exchanges compete with Medicaid and Basic Health Plans?

New York state has followed Minnesota’s lead and set up a PPACA Basic Health Plan (BHP) program.

A state with a PPACA BHP can use its bargaining power to offer low-income residents a choice of several different low-cost, high-value plans.

In New York, the Essential Plan costs either $20 per month per person or nothing. It has no deductible. In New York City, eligible residents have a choice of eight different carriers.

In many other states, Medicaid managers are offering low-income residents a choice of plans from private issuers.

Medicaid managers may find that sending low-income and moderate-income residents a BHP or Medicaid managed care plan options list is cheaper and easier than running a public exchange.

If agents, brokers and insurers like the idea of courting low-income and moderate-income consumers through a subsidized private exchange, rather than leaving those consumers to special programs and focusing on higher-income consumers, this may be the year when they have to make that preference known.

See also: Feds flesh out big new PPACA program

Image: A Florida resident looks for recyclables. (TS/Gregory Witczak)