November 19, 2013
The Affordable Care Act (ACA) is having a bad fourth quarter.
This is a “moment of truth”, as program efforts are being made to guide many different groups—with varying interests—into a single “pipeline” of individuals flowing into the Health Exchanges, where they are to buy the standard insurance products that have been developed.
It is becoming clear that the “pipeline” itself is not yet fully cleared for operations, and that groups are now beginning to understand the implications of being guided (by navigators and others) and pushed (by the individual mandate) into the Exchanges.
One group that has started complaining is made up of individuals who have had limited—and less expensive—health insurance plans in the past, and are resistant to spending more, even if better coverage results (since they are often relatively healthy).
These individuals do not want to enter the pipeline, but they are needed by the program to achieve a balanced representation of the public through the Exchanges.
Insurance companies have started cancelling many of these existing policies, leaving these individuals with no way to stay with their present arrangements.
But at the same time, the federal Exchange, and many state Exchanges, are still not ready for large numbers of customers.
This turmoil has caught the attention of politicians, and is leading to efforts to “postpone the day of reckoning” for this group, so that old policies can continue in effect for at least another year.
A major problem is that excluding these policies will serve to reduce the balanced representation needed by the Exchanges, thereby increasing average premiums.
At another extreme are those who have been totally reliant on the high-risk pools that are now ending—and are desperate to enroll through the Exchanges. The risk pools are closing, but the Exchanges are not yet ready for full-scale operations.
There is a possibility that publicity about high-risk individuals without coverage may begin to surface, forcing another political reaction. Perhaps there will also be pressure to extend the high-risk policies, which could keep more of these individuals out of the Exchanges for now (and help hold premiums down).
Other individuals do not think that their present health care coverage is great—or have none—and are willing to try the Exchanges. They are often frustrated by lack of easy access to the Exchanges. There is a resultant pressure to extend deadlines, which might threaten viability of the ACA.
There is another large group of individuals who are confused and uninformed about the ACA, but are potentially receptive to reasonable guidance. The publicity about problems is pushing them away, reducing program impact.
And others have so far refused to participate, and find support for their attitudes in implementation problems.
Desperate efforts are being made by those with ACA responsibility to maintain the flow of groups moving into the pipeline, by combining temporary coverage fixes with fix-up of the Exchanges. It is yet to be seen whether such temporary strategies can adequately deal with the situation.
More on these and related ACA topics, with an in-depth discussion of organizational reactions to implementation issues, may be found in a recent book by the authors that describes evolution of the ACA, and in a new Practice Guide by the authors that addresses funding and access issues in health care.