Frank Diamond

Managing Editor

Many economists wonder if health insurance exchanges will actually perform one of their primary functions when they open in October — increasing the competition among health insurers offering products to millions of new beneficiaries. This according to Stateline, a wire service for the Pew Charitable Trusts (http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2013/04/23/lack-of-competition-might-hamper-health-exchanges).


States in which multiple insurers already compete are likely to see a continuation. States where one plan dominates — and Stateline lists 10 of them — won’t see any difference, according to economists. Of course, there’s always the possibility that insurers, attracted by a burgeoning market, will take the leap, but “Insurance companies have been mostly silent about their plans, with some citing uncertainty about federal and state rules as a reason for holding back,” according to Stateline.


Insurance companies might not be the only ones not to show for the party. The educated consumer, that much-talked-about but seldom-sighted person of interest, might also hold out. The Kaiser Family Foundation finds that a majority of Americans don’t know what exchanges are (http://tinyurl.com/exchanges-survey). 


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The study was done in March, so hope, if you wish, that a lot of education has gone on in the intervening months. But education is one thing; learning’s another. The Affordable Care Act did foresee the possibility that the uninsured might need some help getting coverage for the first time. So the ACA includes “navigators,” who will help people choose the coverage they need. But will there be enough of them?


California, for instance, wants 21,000 navigators. All of this adds to the costs which adds to the headaches which adds up, some would say, to a fine mess. And the starting pistol has not even been fired. 


Frank Diamond is managing editor of Managed Care.

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