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After ACA, public exchange role may change, insider says

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Christopher Condeluci, a Washington-based health policy specialist who helped create the Affordable Care Act, says the ACA public exchange programs might survive, in some form, even if the Republicans get control of the White House, hold on to control of Congress and set about replacing the ACA.

Condeluci talked a little about how the ACA public exchange system might change in an Affordable Care Act 2.0 World, or an ACA Slayer World, today in an interview at a private exchange data analysis press conference in New York. The press conference was organized by the Private Exchange Research Council. 

Liazon, a Buffalo, New York-based private exchange firm, and Liazon’s parent, London-based Willis Towers Watson, set up the council to get and analyze employee benefits program data from the employers that use Liazon exchange systems. Condeluci, who was tax and benefits to the U.S. Senate Finance Committee while it was drafting the legislation that gave birth to the ACA, served as a moderator

The ACA public exchange system is about to start its fourth annual individual major medical open enrollment period Nov. 1. In spite of gloomy headlines about insurer departures, the issuers still selling coverage through the system could have a great year.

Managers of the surviving exchange programs know a lot more now about how to run an exchange, the remaining issuers know a lot more about how the exchange system and ACA coverage rules and programs work, and consumers know more about the exchange system. The exchange program shakeout has chased many of the low-cost issuers away, meaning that the survivors have a chance to achieve higher profit margins.

If the system does poorly this year, or policymakers decide to change it for political reasons, Congress will face a choice about whether to eliminate the exchange system completely, change it, or “shut it down” and reopen it in a different form, under a new name.

Condeluci said he thinks an overhauled ACA public exchange systems could take two different forms: It could focus on serving as an enrollment system for Medicaid and other programs aimed mainly at low-income people, or it could end up competing head-to-head to private exchange programs.

Related: Health policy shaper: Congress can get things done

The ACA and federal regulators have created exchange programs that act as regulatory agencies, but “you don’t have to structure an exchange like that,” Condeluci said.

The government could allow private exchanges to sell subsidized ACA exchange plan coverage to consumers directly by connecting their computer systems directly to the U.S. Department of Health and Human Services exchange Data Services Hub.

If the private exchange process for selling subsidized plans was more straightforward, and both public and private exchanges could certify whether a health plan met federal subsidy program standards, then and any surviving state-based exchanges could up competing in a vibrant health insurance exchange market, much as the U.S. Postal Service now competes with private package delivery services, Condeluci said. 


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