An article published in the New England Journal of Medicine addressed the potential long term impact of health insurance exchanges, which begin enrolling consumers today, Oct. 1, 2013.
There are 17 states and the District of Columbia that will set up exchanges and another 33 states that will rely on the federal government to operate the exchange. According to the report, the exchanges are expected to experience technical and administrative glitches during the first several months—even years—but likely these difficulties will be solved with time.
According to the article, potential key points to the exchange evolution over the next several years include:
• Offering insurance to businesses with 51 to 100 employees, which they must do starting in 2016;
• Bar insurance companies from selling to individuals and small businesses outside of the exchange, which states now have the power to do, but only two states have exercised that power;
• Advertise information to help consumers make choices;
• Encourage or require participation in accountable care organizations and bundled payments;
• Limit the number of options for contracting.
For the past several days, Republicans in the House of Representatives have tried to block the opening of health insurance exchanges by defunding and delaying health reform implementation, according to various reports. However, they have been unsuccessful and while a government shutdown was forced on Oct. 1, exchange enrollment opened as planned.
"Political resistance may inhibit the use of this instrument," the article authors report. "But over time, as the initial administrative glitches are ironed out, we believe that the exchanges will be seen as a means for promoting a competitive insurance market in which consumers can make rational decisions and that they will become and instrument that can reshape the healthcare delivery system."
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