Heath Insurance Exchanges: Were They the Solution?‎

The exchanges could face more scrutiny now that the federal government is open, according to the author.


OPINION --Diane Lund asked me to reflect upon what the Accountable Care Act (ACA) has done and where we are ‎in its progress, particularly with respect to Health Insurance Exchanges (HIEs). A few months ago, I ‎suggested that it might make sense to delay the individual mandate, given that the employer mandate ‎had been delayed a year. Unfortunately, as of yet, such has occurred. One wonders whether some ‎believe it is better having the individual mandate without the employer mandate or is it just politics as ‎usual. That is, if it is such a good idea to have the individual mandate start a year before the employer ‎mandate why was the original legislation not drafted that way. Or was it read by so few in Congress ‎that it did not matter.‎

Well, we now have the Exchanges, or at least we seem to. The first few days of logging on appeared ‎to be reminiscent of the first few days of logging on to a major airline’s website to print a boarding ‎pass after the information technology “conversion” as part of a major merger. I was in Boston at the ‎time, and I entered what I now believe was an infinite loop. For those of you with programming ‎backgrounds, you know this took me nowhere, but certainly not to a boarding pass. The problems on ‎the first day of the HIEs noted, included “frozen” sites, lags in time, errors, etc. When I could not print ‎my boarding pass from my Boston hotel, I went to the airport a few hours early to try to sort out the ‎situation. Unfortunately, this alternative did not appear to be available to many that sought to access ‎their respective HIE.‎

It never ceases to amaze me that with all the technological advances, implementations and ‎conversions are often so poorly handled and new websites being brought on line like the Exchanges ‎do not seem to work that well at first. A frequent problem cited as to why the first few days for many ‎of the HIEs were difficult was because too many people tried to access them. I thought that was the ‎whole idea to make them available for people to choose a health plan.‎

The hope seemed to be that more people would choose to purchase health insurance, and for those ‎of us less fortunate, there would be subsidies to assist in purchasing that insurance. The hope was ‎that employers would still provide health insurance coverage to their employees. If such was the ‎hope and dream, why are we hearing so many stories of healthy people suggesting they will pay the ‎‎“tax,” certain people not being eligible for the a subsidy, or they do not think it will be enough, but still ‎not qualifying for Medicaid, and employers sending their part-time employees to the Exchanges and/or ‎limiting their hours?‎

When I penned this Commentary at 34,000 feet in the air on a flight to our Nation's Capital, which I was ‎not sure was open or not, I had been looking at an offering for medical and dental insurance for a ‎employer group. That offering for 2014 for an employee and her family cost over $1,400 per ‎month. Although I assume that much of this amount may be subsidized by one's employer, if this is the ‎cost of coverage, how many Oregonians can afford over $16,000 a year for healthcare coverage. Since ‎probably not that many, it is no wonder that so many people flocked to the exchanges on the first few ‎days.‎

There are press reports of the rising prices of the stock of investor-owned hospital companies, in part ‎due to more individuals having health insurance. Yet there also are stories of many nonprofit hospitals ‎laying off workers. There are numerous press reports of how the ACA will exacerbate the clinician ‎shortage and how healthcare might have to be delivered in a different model.‎

Some say this is the Administration’s grand experiment and it will all get sorted out somehow. ‎Perhaps, it will, but like the Government shut down, the debt ceiling, etc., it is a quite painful ‎experiment for many.‎ Now, with the Government back open, more scrutiny may be directed to the Exchanges.

Maybe many more members of Congress should have read what they voted for. Perhaps, they ‎should have looked more carefully at the skyrocketing costs of healthcare in Massachusetts after the ‎enactment of “health reform” there? Perhaps, they should have considered a phase-in? Perhaps, ‎they should have listened less to special interests and focused more on citizens, their healthcare and ‎their access to care?‎

We may never know, but we do know is that not everyone intended to be covered will be covered ‎and not everyone covered will have access to healthcare. One hopes that this hasty “experiment” will ‎not set us back many years in the laudable goal of having all American have access to healthcare. ‎


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