Abstract
As the Affordable Care Act is likely to persist, we should shift our attention toward actually making it work. However, this may be even more challenging than overcoming the initial political opposition. One of the most daunting problems is to make fifty-one insurance exchanges (marketplaces)1 across the country into viable, self-sufficient, and effective entities. Consumer demographics pose a significant challenge to these marketplaces, one that may lead to their demise. Ultimately, it may be prudent to continue high-risk pools as a supplement to marketplaces in order to offer lower premiums in the marketplaces and provide an opportunity for learning. This strategy could be made acceptable to both Republicans and Democrats.
About the author
Simon F. Haeder is a doctoral student in Political Science and a Master’s student in Agricultural and applied Economics at the University of Wisconsin-Madison. His research interests include healthcare policy, regulatory policy-making, and theories of the policy process. He is currently working on several research projects in health policy focusing on the implementation of the Affordable Care Act and insurance regulation. He is also investigating the incidence and effect of regulatory lobbying.
- 1
The original terminology used by the Affordable Care Act is “health insurance exchanges.” However, in January 2013, citing concerns for non-English speakers, the Obama administration officially decided to rebrand the exchanges as “health insurance marketplaces.” I will follow the new terminology in this paper.
- 2
Ironically, the approach offered by Arkansas which seeks to expand its Medicaid program through premium support for insurance marketplaces may help to improve the conditions of insurance pools.
- 3
Moreover, the Obama Administration recently decided not to enforce the employer mandate at least until 2015.
References
Blewett, Lynn A., and Donna Spencer. 2008. State High Risk Pools: An Overview. Minneapolis, MN: State Health Access Data Assistance Center.Search in Google Scholar
Cauchi, Richard. 2012. Coverage of Uninsurable Pre-Existing Condit Ions: State and Federal High-Risk Pools. Denver, CO: National Conference of State Legislatures.Search in Google Scholar
Center for Consumer Information & Insurance Oversight. 2013. Covering People with Pre-Existing Conditions: Report on the Implementation and Operation of the Pre-Existing Condition Insurance Plan Program. Washington, DC: Centers for Medicare & Medicaid Services, U.S. Department of Health & Human Services.Search in Google Scholar
Chollet, Deborah J. 2010. “How Temporary Insurance for High-Risk Individuals May Play out under Health Reform.” Health Affairs 29 (6): 1164–1167.10.1377/hlthaff.2010.0458Search in Google Scholar
Congressional Budget Office. 2011. CBO’s March 2011 Baseline: Health Insurance Exchanges. edited by Congressional Budget Office. Washington, DC.Search in Google Scholar
Fernandez, Bernadette. 2011. Health Insurance: State High Risk Pools. Washington, DC: Congressional Research Service.Search in Google Scholar
Gardiner, Terry. 2012. “Health Insurance Exchanges of Past and Present Offer Examples of Features That Could Attract Small-Business Customers.” Health Affairs 31 (2): 284–289.10.1377/hlthaff.2011.1006Search in Google Scholar
Hadley, Jack, John Holahan, Teresa Coughlin, and Dawn Miller. 2008. “Covering the Uninsured in 2008: Current Costs, Sources of Payment, and Incremental Cost.” Health Affairs 27 (5): w399–w415.Search in Google Scholar
Haeder, Simon F. 2012. “Beyond Path Dependence: Explaining Healthcare Reform and Its Consequences.” Policy Studies Journal 40 (S1): 65–86.10.1111/j.1541-0072.2012.00446.xSearch in Google Scholar
Haeder, Simon F., and David L. Weimer. 2013. “You Can’t Make Me Do It: State Implementation of Insurance Exchanges under the Affordable Care Act.” Public Administration Review. doi: 10.1111/puar.12065.10.1111/puar.12065Search in Google Scholar
Hall, Jean P., and Janice M. Moore. 2012. Realizing Health Reform’s Potential: The Affordable Care Act’s Pre-Existing Condition Insurance Plan: Enrollment, Costs, and Lessons for Reform. New York: The Commonwealth Fund.Search in Google Scholar
Hall, Mark A. 2012. “Regulating Stop-Loss Coverage May Be Needed to Deter Self- Insuring Small Employers from Undermining Market Reforms.” Health Affairs 31 (2): 316–323.10.1377/hlthaff.2011.1017Search in Google Scholar
Henry J. Kaiser Family Foundation. 2011. A Profile of Health Insurance Exchange Enrollees. Menlo Park, CA: Henry J. Kaiser Family Foundation.Search in Google Scholar
Kramer, William E. 2012. “Large Employers See Scenarios under Which They Could Move Workers and Retirees to Exchanges.” Health Affairs 31 (2): 299–305.10.1377/hlthaff.2011.1030Search in Google Scholar
Laudicina, Susan S. 1988. “State Health Risk Pools: Insuring the ‘Uninsurable’.” Health Affairs 7 (4): 97–104.10.1377/hlthaff.7.4.97Search in Google Scholar
Le Grand, Julian. 2007. The Other Invisible Hand: Delivering Public Services through Choice and Competition. Princeton, NJ: Princeton University Press.Search in Google Scholar
Le Grand, Julian. 2010. “Knights and Knaves Return: Public Service Motivation and the Delivery of Public Services.” International Public Management Journal 13 (1): 56–71. doi: 10.1080/10967490903547290.10.1080/10967490903547290Search in Google Scholar
Merline, John. 2013. “Obamacare Exchange Subsidy Cost Hiked by $233 Billion.” Investors Business Daily, February 5.Search in Google Scholar
Monahan, Amy, and Daniel Schwarcz. 2011. “Will Employers Undermine Health Care Reform by Dumping Sick Employees?” Virginia Law Review 97: 125–197.Search in Google Scholar
Mulvey, Janemarie. 2013. Potential Employer Penalties under the Patient Protection and Affordable Care Act (ACA). Washington, DC: Congressional Research Service.Search in Google Scholar
Mulvey, Janemarie, and Hinda R. Chaikind. 2012. Individual Mandate and Related Information Requirements under ACA. Washington, DC: Congresional Research Service.Search in Google Scholar
Nather, David, and Carrie Budoff Brown. 2011. “Republicans Eye Costs, Not Uninsured.” Politico, January 24.Search in Google Scholar
Pauly, Mark V. 2008. “Blending Better Ingredients for Health Reform.” Health Affairs 27 (6): w482–w491.10.1377/hlthaff.27.6.w482Search in Google Scholar
Pecquet, Julian. 2010. “Abortion Coverage Restricted in High-Risk Insurance Pools.” The Hill, July 29.Search in Google Scholar
Pressman, Jeffrey L., and Aaron Wildavsky. 1973. Implementation: How Great Expectations in Washington Are Dashed in Oakland; or, Why It’s Amazing That Federal Programs Work at All, This Being a Saga of the Economic Development Administration as Told by Two Sympathetic Observers Who Seek to Build Morals on a Foundation of Ruined Hopes. Berkeley: University of California Press.Search in Google Scholar
PricewaterhouseCoopers Health Research Institute. 2011. Change the Channel: Health Insurance Exchanges Expand Choice and Competition.Search in Google Scholar
Stawicki, Elizabeth. 2011. “Study: Employers Could Dump Sickest Employees on Public Health Care.” Kaiser Health News, November 30.Search in Google Scholar
U.S. Government Accountability Office. 2012. Comparison of Implementation and Early Enrollment with the Children’s Health Insurance Program. Washington, DC: U.S. Government Accountability Office.Search in Google Scholar
Vestal, Christine. 2011. “High-Risk Health Care Plans Fail to Draw Crowd.” Stateline, September 6.Search in Google Scholar
©2013 by Walter de Gruyter Berlin Boston
