Okay, deep breath here folks.
There’s no question the Federal Exchange is a mess. And that’s the polite characterization.
But let’s not get too carried away, because the Federal Exchange is just a small part of PPACA/Obamacare. In fact, the Exchange impacts just 7% – seven percent! – of the US population. Thus, it is:
- Irrelevant for most Americans – specifically the 80% who get their insurance from their employer or are covered by Medicare or already covered by Medicaid.
- Not operating in 16 states plus DC, and that includes a couple of big ones – California and New York specifically. In general, those exchanges are doing pretty well. Yes there are significant problems in Hawaii, Maryland and a couple other states, but overall they’re doing fine.
- Operating in states where 59% of today’s uninsured live. Sure that’s a lot, but it isn’t everyone, not even close. And, a big chunk of that 59% are not eligible for coverage for various reasons (undocumented, state refused to expand Medicaid, etc.)
And, the Federal Exchange is just one part of Obamacare.
It is a means to an end, and that “end” is covering as many eligible people as possible, while fundamentally changing the competitive marketplace to force insurers to compete based on delivering the best outcomes at the lowest price.
Key components of Obamacare already implemented include:
- Medicaid and CHIP expansion, providing coverage to the growing population of people who don’t make enough money to buy their own coverage, or who work for small companies that don’t provide insurance.
- Credits to help small businesses buy coverage
- Elimination of medical underwriting, lifetime caps, and coverage of dependents to 26
- Allocation of funds to Comparative Effectiveness Research to promote treatments that actually work.
- Policy changes and funding for new delivery systems and reimbursement arrangements, funding which has generated explosive growth in Accountable Care Organizations and Medical Home-based models.
What does this mean for you?
Eventually, the federal exchange will be fixed. Meanwhile, our health care “system” is going thru drastic change, change that will, over the long term, improve the health care we get and reduce the cost of that care.
Of course, there’s going to be some well-deserved political fallout in the interim.