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Understanding the implications of ACA enrollment – separating the political from the practical

When it comes to understanding how the ACA will affect your business, you have to separate the politics from the practical.

In this case, remember that “Politics are national; health care is local.”

The pundits (and I’d have to include myself in this category at times, altho I’m an amateur at best) use the national enrollment numbers to declare victory or defeat. That’s fine for a parlor exercise, but practically, the national data matters not one whit for health plans, providers, and work comp payers.

No, for business folks, what matters is what’s happened/happening in their state, and more precisely their operating area. In some states (Vermont – 280% of projections, California, Michigan, North Carolina – 155%), enrollment is robust.  In others (Ohio, Arkansas, West Virginia) enrollment is well under projections.

Medicaid expansion, state-based exchange success or failure, and the political environment greatly affected enrollment; politicians in some states actively discouraged/tried to prevent ACA enrollment while in others the exchange was a mess (e.g. Oregon).

Regardless, the higher the enrollment, the more likely you will see ACA impact;

  • the health care provider community,
  • adoption of different care delivery and reimbursement models,
  • more or less incentive to cost shift to work comp,
  • and access to key specialists.

Current state-specific enrollment data is here.

What does this mean for you?

Depends on where you do business…

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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