Health Care
5:35 am
Sun September 29, 2013

Insurance Exchanges Will Open To Scrutiny, Curiosity, Confusion

Originally published on Mon September 30, 2013 11:51 am

Tuesday is a big day for the White House. That's when new health insurance exchanges open in every state, where people can buy the insurance the Affordable Care Act requires next year. They will also see if they qualify for new subsidies to help them afford it.

The day will be met by both intense scrutiny and complete cluelessness. Policy wonks will be watching like scientists running lab rats through a maze.

Camped on the virtual sidewalk outside the new exchanges, just waiting for the online doors to open, are people like Caroline Pearson, a vice president at Avalere Health, a Washington, D.C., consulting firm. She says she knows a lot of people who are just dying to take the federal government's new health insurance shopping system for a spin when it opens Tuesday morning.

"I think that every health care researcher in the country is going to immediately log in to the website — and hopefully not overwhelm the system and crash the website," she laughs.

Researchers like Pearson want to see if the technology really works. They want to compare prices across the country, know who's buying and how much people are willing to spend. They want demographics, consumer behavior, prices — data, data, data.

At the other end of the spectrum are the estimated 80 million Americans who say they don't know anything about the law and may not notice at all.

Spreading The Word

Sarah Kos is trying to get the word out in Colorado. She's one of thousands of people across the country who are getting federal grant money to help people buy insurance on the new marketplaces.

"I went through all their training, knocked it out in a week," Kos says. "Now, did I retain all that? I hope so."

Koss recently fired up her PowerPoint slides at the headquarters of Colorado's trucking association. Truckers, like many other independent businesspeople, could potentially benefit from the health care law because they don't get insurance through their jobs.

But only six people showed up.

James Ruder is one. He owns a company that makes wooden shipping pallets.

"I don't even know what I can legally do and can't at this point," he says.

Ruder is clued in enough to at least start asking questions, but says he still has gaps in what he needs to know about the health care law. One thing he's pretty sure of, though: His employees won't want to spend any money on health insurance.

"They live check-to-check," he says. "It's just the lifestyle that they're in, and every dollar matters. I just can't even imagine a sacrifice like this."

After getting a subsidy, that sacrifice would be about $40 a month for the lowest-priced plan for his lowest-paid worker, who makes $10 an hour.

Someone who's making his top-end wage, $15 an hour, would pay a little more. Subsidized coverage for that worker, plus a spouse and child, would run about $90 a month.

That would be a big expense for Ruder's employees.

"You'd be surprised," he says. "We make a $2 error on their check, they're standing there to have another check cut. They can't even wait till the next week."

Luring The Young And Healthy

Pearson, the researcher, hopes that low-wage workers like Ruder's at least show up and look around once the exchanges open Tuesday.

"The real question is, can you reach the uninsured who have health care needs but haven't been getting coverage before, and get them into the system?" she says. "That, I think, is what we really need to focus on to decide if this is successful."

Pearson thinks sicker people, and those worried about their health, will be more motivated to shop on the exchanges, even if they're only making $10 an hour.

"Whether or not you get any of the young, healthy people in, in year one, I think that is a major open question at this point," she says.

Getting those young people in is going to be important. Health insurance will only work if healthy people who don't need much care are paying into the system, to help cover the costs of sicker people who will use a lot of health care.

So expect to see more TV ads featuring young, healthy people feeling really awesome about buying health insurance, like this one from Colorado:

States and the White House have a lot riding on persuading millions of Americans to buy health insurance. Pearson says they only have a little time.

"You've got a few years in which the market can handle a bit of a sicker population," she says. "But in order for it to be stable in the long term, you really need to get those healthy folks in."

That means it will take at least a couple years to know whether Obamacare's exchanges are going to work.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

RACHEL MARTIN, HOST:

This is WEEKEND EDITION from NPR News. I'm Rachel Martin.

Tuesday is a big day for the White House. That's when new health insurance marketplaces, called exchanges, are scheduled to open in every state. They're set up so people can buy the insurance that the health care law requires, and see if they qualify for new subsidies to help them afford it. Politicians, people who study health care, those working day and night to get the marketplaces ready say come Tuesday, they will be up and running. But many Americans still say they don't understand the upcoming changes.

Eric Whitney reports.

ERIC WHITNEY, BYLINE: Who's camped on the virtual sidewalk outside the new health care exchanges, just waiting for the online doors to open? People like Caroline Pearson, a vice president at Avalere Health, a Washington, D.C. consulting firm. She says she knows a lot of people who are just dying to take the federal government's new health insurance shopping system for a spin when it opens Tuesday morning.

CAROLINE PEARSON: (Laughing) I think that every health care researcher in the country is going to immediately log into the website, and hopefully not overwhelm the system and crash the website.

WHITNEY: Researchers like Pearson want to see if the technology really works. They want to compare prices across the country. They want to know who's buying and how much people are willing to spend. They want demographics, consumer behavior, prices - data, data, data.

At the other end of the spectrum, most of the rest of America.

SARAH KOS: So, I'm just going to go ahead and get started.

WHITNEY: Sarah Kos is trying to get the word out. She's one of thousands of people across the country getting federal grant money to help people buy insurance on the new marketplaces.

KOS: So I went through all their training, knocked it out in a week. So I'm like, yes. (Laughing)

Now, did I retain all that? I hope so.

WHITNEY: Today, Kos is firing up her PowerPoint slides at the headquarters of Colorado's trucking association. A lot of truckers are independent businesspeople who could potentially benefit from the health care law because they don't get insurance through their jobs. But only six people show up at the two sessions Kos does today.

James Ruder is one. He owns a company that makes wooden shipping pallets.

JAMES RUDER: I don't know. And I don't even know what I can legally do and can't at this point.

WHITNEY: Ruder is clued in enough to at least start asking questions, but says he still has gaps in what he needs to know about the health care law. One thing he's pretty sure of, though: His employees won't want to spend any money on health insurance.

RUDER: They live check to check. It's just the lifestyle that they're in, and every dollar matters. I just - I can't even imagine a sacrifice like this.

WHITNEY: The sacrifice would be about $40 a month for the lowest-price plan for his lowest-paid worker, making $10 an hour. That's after getting a subsidy. Someone who's making his top-end wage, 15 bucks an hour, would pay a little more. Subsidized coverage for that worker plus a spouse and child would run about $90 a month.

RUDER: You'd be surprised, we make a $2 error on their check, and they're standing there to have another check cut. You know, they can't even wait till the next week.

WHITNEY: Caroline Pearson hopes that low-wage workers like Ruder's will at least show up and look around once the exchanges open Tuesday.

PEARSON: The real question is, can you reach the uninsured who have health care needs but haven't been getting coverage before and get them into the system? And that I think is what we really need to sort of focus on to decide if this is successful.

WHITNEY: Pearson thinks sicker people and those worried about their health will be more motivated to shop on the exchanges, even if they're only making $10 an hour.

PEARSON: You know, whether or not you get any of the young, healthy people in, in year one I think that is a major open question at this point.

WHITNEY: Getting those young people in is going to be important. Health insurance will only work if healthy people who don't need much health care are paying in to help cover the costs of sicker people who will use a lot of health care. So expect to see more TV ads featuring young, healthy people feeling really awesome about buying health insurance, like this one from Colorado.

(SOUNDBITE OF HEALTH CARE AD)

UNIDENTIFIED MAN: So what actually happens when dozens of plans compete for your business?

(SOUNDBITE OF CHEERING)

UNIDENTIFIED MAN: You win.

WHITNEY: States and the White House have a lot riding on persuading millions of Americans to buy health insurance. Pearson says, they have a little time.

PEARSON: You've got a few years in which the market can handle a bit of a sicker population. But in order for it to be stable in the long term, you really need to get those healthy folks in.

WHITNEY: That means knowing whether Obamacare is going to work will take at least a couple of years. And the exchanges are just one part of the law - the part that involves getting more people covered. The Affordable Care Act has already started regulating insurance companies, setting a minimum for how much they have to spend on health care.

The law is also creating new pilot programs for doctors, giving them incentives to be more efficient in hopes of saving money and giving better care.

For NPR News, I'm Eric Whitney.

MARTIN: This story is part of a collaboration with NPR and Kaiser Health News.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

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