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Who benefits from looming health insurance exchange deadlines?

Doctors in surgery

Photo by Flickr user SarahMcD

The re-election of President Obama has brought a number of fiscal and policy issues into focus, one of which is the fate of the 2010 Patient Protection and Affordable Care Act, otherwise known as Obamacare.

The preservation of the health insurance reform law, which was upheld by the Supreme Court in June, clearly has myriad business and financial angles as well as political and policy issues yet to be settled.  One that offers some immediate opportunities for business writers is the question of the health insurance exchanges that states may opt to set up in order to provide consumers with a marketplace for comparing insurance plans.

The U.S. Department of Health and Human Services just gave states an extension (until mid-December) for providing thier actual plans for the exchanges, but they still must notify the federal government by Friday about whether or not they plan to create one in the first place.

So far, not many takers.  Here’s a map from the National Conference of State Legislatures showing few states have enacted legislation to create the programs; some likely were waiting for the election outcome while others, like Missouri, are leaving it to the federal government to set up an exchange for their citizens.

Even though these are largely political questions, and on a vast and complex topic to boot, you still can ferret out interesting business profiles, features and consumer stories as the health insurance exchange question unfolds.

One good source to bookmark is HealthReformGPS, a site run by Georgetown University and the Robert Wood Johnson Foundation, which is an information clearninghouse and treasure trove of story ideas.  For example, I had not previously heard of the Small Business Health Options Program(s), or SHOPs,  a provison of the ACA that requires small businesses be provided a health insurance exchange where companies with fewer than 100 employees (or fewer than 50 until 2016, if individual states choose) can shop for competitive policies.  Some very small employers can qualify for a tax credit up to 35 percent of premiums if they meet certain criteria, like average worker wages less than $50,000, if they buy through SHOP.  This is the sort of procedural information that hasn’t been widely publicized as the overarching fate of the ACA has been discussed; now is a good time to start drilling down into the details.

A primer on how the exchanges will work is a good place to start; I’m still perplexed about how this online marketplace — likened to an Expedia or Travelocity for health insurance — provides more than convenience; how does the competition affect pricing and premiums?  Presumably the larger pooled of insured will drive prices down; time will tell.  Here’s a Kaiser Family Foundation primer on the concept of exchanges.

However consumers end up faring under the programs, the establishing of exchanges is big business; check out this Washington Post Wonkbook entry about the complexity of administering an exchange; if you parse all of the functions on the flow chart you’ll see there are plenty of jobs for consultants, trainers, software writers, administrators, accountants, marketing experts and so on.  Project managmeent firms like Public Consulting Group and Deloitte likely have good sources in your market who (keeping in mind their commercial interests) can help you understand the scope and financial ripple effects of exchanges.

Don’t forget to check in with market research firm IBISWorld for their latest report on the $707 billion health insurance industry, too, for their insight into the effects of the ACA on industry players.


In Beats, Health care, Insurance, Personal finance, Small | Private | Non-profit, Story ideas.

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