Insurance exchange impacts more than just enrollment numbers


Editor's Corner

Brian Eastwood, Senior EditorThe biggest payer story of the otherwise light holiday news cycle was the Obama administration's announcement that roughly 4 million people used either or a state insurance exchange to select a health plan in time for Jan. 1 enrollment.

It's certainly a good sign, as it shows that both new and existing consumers remain interested in using the insurance exchanges. However, truly judging the impact of the exchanges requires more than just a cursory glance at the numbers.

For starters, the numbers are confusing. The Department of Health and Human Services reported that 3.4 million people selected plans on one week after saying 6.4 million people used the site. It takes a couple readings to understand this. The former refers to consumers who went to the site and chose a plan; the latter includes those consumers, as well as anyone who was automatically re-enrolled in an existing plan.

The numbers don't paint a true picture yet, either. Different state exchanges have different enrollment deadlines due to technical problems, inclement weather or a desire to accommodate procrastinators. States have thus far also reported enrollment figures differently. Some announced new enrollees; some announced new and "active" enrollees, and some announced new, active and automatic enrollees. Trying to make sense of all that is enough to make you want to reach for one last glass of holiday eggnog.

Instead of heading for the refrigerator, consider instead the larger impact of the exchanges: They're getting consumers to talk about health insurance.

When I first entered the working world, I gave little thought to my insurance. I picked whatever plan was cheapest, with little regard for premiums, co-pays, deductibles, referrals or networks. Sure, life was easier back then, not to mention less expensive, but I had no idea what I was doing. Luckily, I never needed care beyond annual physicals, minor gum surgery, and separate bouts with the flu and pink eye.

Obviously, times have changed. As consumers have balked at rising healthcare costs, insurers have responded with more choices--high-deductible health plans for the healthy, high-premium "Cadilac" plans for those who want peace of mind, narrow networks for those who don't need a wide range of services and so on. Payers have also introduced a variety of health and wellness plans to help members get healthy, stay healthy and avoid going to the doctor in the first place.

Trying to make sense of all that is enough to make you want to reach for one last glass of holiday eggnog, too. That's why conversations are so important. Workers can turn to benefits or human resources departments with questions. Medicare and Medicaid recipients can call hotlines or visit government offices.

Until recently, the uninsured, the underinsured or those who just wanted to shop for a better deal didn't get that kind of help. The insurance exchanges--and the service and support systems built around them--now let those consumers start the conversation.

In the end, that level of consumer education about health insurance will matter more than the number of people who use the exchanges. -- Brian (@Brian_Eastwood and @HealthPayer)

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