Many states will be setting up health insurance exchanges even if the Patient Protection and Affordable Care Act (PPACA) vanishes, and the exchanges that succeed will probably be the ones that do a good job of reaching out to brokers.
Ron Goldstein, president of CHOICE Administrators, Orange, Calif., gave that assessment Monday at a session on exchanges at the annual convention of the National Association of Health Underwriters (NAHU), Washington.
PPACA calls for states to set up exchanges, or Web-based insurance supermarkets, that individuals can use to sign up for public health insurance programs or use new subsidies to buy commercial coverage. PPACA also calls for states to offer SHOP exchange programs for small businesses, together with the individual market exchange programs or through separate systems.
States can choose whether to set up their own exchanges or let the U.S. Department of Health and Human Services (HHS) provide exchange services for their residents.
Many private groups and some states have been running exchanges or exchange-like programs since the 1980s.
Goldstein said he is confident that at least 15 to 20 states will be moving ahead with efforts to set up PPACA-influenced exchanges, even if the Supreme Court kills PPACA.
The states moving ahead with exchange programs include PPACA-backing states such as Oregon and Washington, but the list of states with fast-moving exchange programs also includes Arizona and Mississippi, Goldstein said.
CHOICE has found through direct experience in California that "you can't have an exchange without brokers," Goldstein said.
The companies that start and run exchanges are really technology companies, not sales, Goldstein said.
Goldstein said that HHS has been offering states a great deal of flexibility, and that the differences in state exchange programs could cause challenges for brokers and others.
Each state has its own quirks, and one, for example, has been insisting on a "zero paper" enrollment process, Goldstein said.
But, overall, "this isn't that complicated," Goldstein said.
Goldstein said most states seem to get that brokers are vital to promoting the exchanges.
"I think you'll get paid," he said. "I don't know what you'll get paid."
But federal involvement likely will lead to more complexity and confusion, and, in the long run, confusion should be great for good brokers, he said.
"Embrace what's happening," Goldstein added. "Because it's going to happen."
Don Garlitz, executive director of the exchange solutions arm of bswift Inc., Chicago, said at another session on exchanges that he also is confident that many states will set up exchanges no matter what the Supreme Court or Congress do about PPACA.
If PPACA survives, then HHS officials are supposed to arrange to provide exchange services for residents of states that cannot or will not set up exchange systems.
"The idea that the federal government will run 25 exchanges keeps them up at night," Garlitz said. "They don't want that."
But, if PPACA implementation moves ahead, then HHS will get some kind of exchange systems in place by the required time, Garlitz predicted.
Correction: An earlier version of this article described NAHU's location incorrectly. NAHU has moved to Washington.