October 1, 2013
This is #13 in a series of Obamacare Reports. (See also postings by Mitchell Law Office)
Implementation of the Affordable Care Act (ACA) is moving into a new phase as the Health Exchanges are scheduled to “go live” on October 1. This is a notable date, as a long period of preparation begins to transition into the start of operations.
Focus will now shift from how to prepare for the start-up date, to how to perform post-startup strategies. It is not yet clear what conclusions will be drawn by individuals and organizations regarding their interests and strategies after full operations are in effect.
There are likely to be new appraisals of the situation, based on an intense examination of how the new operations are proceeding.
It is to be expected that the performance of all Exchanges will be subjected to a high level of scrutiny, as will the reactions by participants. The next few months are likely to be characterized by information collection, analysis, and revised game plans.
Attorneys can survey this process by keeping an eye on a set of performance indicators that demonstrate how implementation is proceeding. These indicators may be more revealing than ongoing rhetoric.
An overview assessment may involve: watching the numbers of health insurance policies sold through the Exchanges, by category; tracking enrollment in the expanded Medicaid programs, in states where available; and observing typical individual and small-business experiences with the Exchanges.
A major indicator will be the numbers of insurance policies purchased by individuals, by age category. The ACA objective is to achieve a balance among groups that is not skewed toward seniors or the disabled. Marketing for the ACA and counter-marketing against the ACA will both be amended “on the fly” in light of the actual sign-up numbers.
On another front, the dialog between large employers and the Department of Health and Human Services (HHS) over delayed implementation of the large-employer mandate may be evaluated in terms of published accounts of the discussions that are taking place. More cooperation for 2015 likely means that present implementation seems to be going reasonably well.
More directly, the numbers of small-business group policies purchased through the Exchanges can indicate participation levels and attitudes.
Many of the sales results for individual and small-business insurance policies will likely be posted on federal and state websites. Marketing and counter-marketing will both be assessed and redesigned in light of the actual sign-up numbers.
The levels of involvement by various insurance companies can be observed in terms of the numbers of policies sold, by type, and by company press releases.
Federal agencies will likely assess Health Exchange operations in terms of the numbers of policies sold, how accurately subsidies are being awarded, and whether major implementation problems are being avoided.
Providers will be in an intense period of self-evaluation regarding readiness to serve additional patients— although published indicators may be hard to come by due to concerns about safeguarding proprietary information.
By watching these indicators, attorneys may “ride along” with the implementation process, and remain current with the situation on behalf of clients.
More on these and related ACA topics may be found in a recent book by the authors that describes implementation of the ACA, and in a new Practice Guide by the authors that addresses funding and access issues in health care.
Previous installments of “Obamacare Reports” address the various ways in which implementation of the ACA is affecting legal practices: