Access to Care Report (#8) / ACA exchanges to vary by branding, state, strategies

August 29, 2013


This is #8 in a series of Access to Care Reports. (See also postings by Mitchell Law Office)

Access to care through the new Health Exchanges will inevitably vary by “branding”, state, and the strategies in use.

As attorneys seek to assist clients in coping with the Affordable Care Act (ACA), a significant investment of time and effort may be required to understand all of the issues related to access in a specific state (and community).

The Exchanges are scheduled to become operational on October 1, 2013, and it seems likely at present that they will be able to start up on this date. But these initial Exchange models will be just the first versions to be implemented, and may be expected to evolve rapidly.

These initial models are likely to be based on operational compromises necessary to get “up and running”. Computer systems will be in “Release 1” versions, reflecting designs that have been found feasible within the urgent schedule, late start, and limited resources.

It may be expected that applications for insurance will require some manual processing assistance for start-up operations.

Interactions between the “data hub” set up by the Department of Social and Health Services (HHS) and the Exchanges will also evolve rapidly.

Each Exchange has adopted its own name, and will rapidly become a distinctive organizational “brand”.

Adaptation to state and local conditions may also be expected, as “more generic” Exchange models give way to meeting the real-world needs of specific populations.

Within a short length of time, it may be expected that Exchanges will take on their own character and procedures, as managers and staff struggle to meet the needs that they encounter.

As individuals and small businesses gain experience with the new marketplaces and purchase insurance coverage, their reactions will help shape Exchange strategies and operations. The result will be a national approach to ACA implementation combined with distinctive state-by-state variations.

The changing Exchanges will reflect—and affect—how health care services are viewed by individuals and how providers arrange for and deliver services.

In this situation, it will be important for attorneys to gain an understanding of the essential features of the Exchanges in the states where they practice. Information may be directly obtained from Exchanges, where possible.

On the other hand, information regarding the federal and partnership Exchanges (about two-thirds of the total) may have to be obtained through federal agencies. Information regarding the state Exchanges (about one-third of the total) may be available through state agencies.

Web pages and public information will be readily accessible. But detailed information regarding specific Exchange operations may be difficult to come by, particularly during the first year of operations.

And any challenges to Exchange decisions promise to lead into unexplored territory.

Previous installments of “Access to Care Reports” address the various ways in which access to care issues are affecting legal practices:

Report #1   Report #2   Report #3   Report #4   Report #5   Report #6   Report #7