Daunting challenges loom as ACA exchange deadline nears

Reuters

Article Highlights

  • ACA’s mechanisms for expanded coverage can’t “exchange” a host of implementation problems immediately ahead

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  • Where’s the money to run federal exchanges?

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  • The early wave of bad news and poor outreach for the exchanges is keeping many wary and disengaged

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Editor’s note: The following article is excerpted from a Q&A with Tom MIller and other health policy experts, written by Jeff Overley. It originally appeared on Law360 on June 7, 2013. The full text is available here

Law360, New York (June 07, 2013, 3:29 PM ET) -- The Affordable Care Act’s fate rests heavily on health insurance exchanges set to debut Oct. 1, and while the Obama administration is vowing that the online marketplaces will be ready to go, experts say technological challenges, higher premiums and funding woes are among the many potential stumbling blocks standing in the way of a smooth rollout.

Law360 talked with a half-dozen observers who varied widely in their assessments of the prospects for success, with some predicting the exchanges will overcome minor hiccups and others warning that an administrative catastrophe is entirely possible.

Their lightly edited comments are included below.

Thomas P. Miller – Resident Fellow, American Enterprise Institute

Their official name was changed recently to “marketplaces,” but the ACA’s mechanisms for expanded coverage can’t “exchange” a host of implementation problems immediately ahead.

Will complex information technology wiring trying to integrate multiple databases in real time for the first time actually work? Expect multiple misfires and derailments.

Wider choice of health plans for employees in small businesses using the health exchanges? Postponed.

Substantial interest and enrollment by the currently uninsured? The early wave of bad news and poor outreach is keeping many wary and disengaged.

Seamless eligibility determinations that are integrated with Medicaid coverage? Doesn’t seem likely for 2014, with less than half of the states agreeing to Medicaid expansion.

Where’s the money to run federal exchanges? Expect the secretary of the U.S. Health and Human Services Department to start organizing bake sales after coercing regulated insurers to “give till it hurts” doesn’t work.

What about the wild card that could bring federally administered exchanges to a crashing halt? Two lawsuits in federal courts pose serious challenges to an Internal Revenue Service rule authorizing federal premium assistance tax credits in exchanges that are not “established by a state.”

So, it looks like full speed ahead, right over the cliff! 

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About the Author

 

Thomas P.
Miller
  • Thomas Miller is a former senior health economist for the Joint Economic Committee (JEC). He studies health care policy and regulation. A former trial attorney, journalist, and sports broadcaster, Mr. Miller is the co-author of Why ObamaCare Is Wrong For America (HarperCollins 2011) and heads AEI's "Beyond Repeal & Replace" health reform project. He has testified before Congress on issues including the uninsured, health care costs, Medicare prescription drug benefits, health insurance tax credits, genetic information, Social Security, and federal reinsurance of catastrophic events. While at the JEC, he organized a number of hearings that focused on reforms in private health care markets, such as information transparency and consumer-driven health care.
  • Phone: 202-862-5886
    Email: tmiller@aei.org
  • Assistant Info

    Name: Neil McCray
    Phone: 202-862-5826
    Email: Neil.McCray@aei.org

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