Marketing Exchanges or Exchanging Marketplaces?

One of the joys of running Health 2.0 is that we see things before they’re unveiled. Right now one of the biggest unveilings in the history of consumer health IT is a scant 60 days away. I’m talking about the Federal and State Exchanges for health insurance, mandated by the ACA. Now the careful reader may know that fewer than half the states are developing their own exchanges, even fewer probably realize that there are already several tech and benefits companies running private exchanges for employers, primarily for their retirees. And of course there are online brokers like eHealth who have been marketing direct to consumers for years. And now exchanges are being called “marketplaces” and being developed at a high cost with an impending deadline.

Soon things are going to really accelerate. Individuals will find that they need to buy insurance via the state exchanges in order to get the subsidies. But if there’s no state exchange, they can do it via the Federal exchange. They’re also going to have to estimate their income, and then verify that at the IRS (automatically via the exchange, we hope) to get subsidies. Most of the exchanges will have a similar look and feel (based on some design work done with IDEO) but private players like Getinsured.com will have their own system outside the marketplaces–even though they are also a vendor to Covered California (the single biggest state marketplace). It appears that some private exchanges will also provide access to the subsidies which we think includes access to that IRS verification. So we could see private exchanges compete with the public ones.

Many people don’t realize that small businesses can also buy via the exchange. They don’t get subsidies, but they may get tax credits. Would they be better off just giving their employees cash (or not) and sending them into the exchanges? If a small employer gives their employees cash and sends them into the exchange, are they paying with pre- or post-tax dollars? And will tech based players like eHealth start helping small employers to go around the exchanges? These were all questions I asked on Healthcare.gov (yes, you can IM with an “expert”) and no, they didn’t know the answer.

The concept is simple. Get a better choice of hopefully cheaper standardized health plans via a marketplace, and also get a subsidy if you need one. The reality is that we’re going to be negotiating the business of exchanges and the technology implications of this for some time. Like the rest of America, there’ll be lots of options depending on who you are and what you need.

And I’m thrilled to say that many of the leaders in the exchanges/marketplace world will be at Health 2.0 on October 1–not coincidentally the day the exchanges open for business!

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