The challenges and dynamics of supporting the ACA marketplace

The challenges and dynamics of supporting the ACA marketplace

This week I have been at the Blue Cross Blue Shield Annual Summit in Orlando, Florida. The Blue Cross and Blue Shield companies annually spend over $15bn on goods and services so it’s an important event and is a great occasion to meet people from the health and insurance sector – to network and share ideas.

This year I have been particularly interested in talking to people at the event about the challenges and opportunities of the Affordable Care Act (ACA) Marketplace. Some plans are really struggling with it, but others are finding that they can run a profitable business so what are the issues and why can’t every company get it right?

Of course one of the main challenges is just keeping track of the legislation itself because it has been rolled out gradually since 2010 and will continue changing slowly until all the presently planned for provisions are accommodated in 2020. So the implementation of provisions is ongoing and changing one or two times a year at least for the next four years – then who knows what new changes might apply after those that we know of right now?

But the real challenge that will define the future of the ACA is how effectively federal and state administrators will be in signing people up during the last open enrollment period before the next election. If a lot of people sign up now and are generally happy then it will be difficult for the new administration to make changes in 2017 and beyond.

Ten million American households, most of them uninsured before, now have insurance purchased on the marketplace. Medicaid programs now cover 14.6 million more people than before the ACA and the number of households without insurance has dropped from 16% in 2010 to 9.2% in 2015.

Many industry commentators have suggested that the increased participation of millions of new insurance customers has created a ‘retailization’ of the marketplace. It remains a complex product, but many in the healthcare industry are trying harder to help customers understand their rights and what is available.

To my mind all these opportunities and challenges related to ACA point in one single direction, that the customer experience is going to be vital for every healthcare and insurance organization involved in providing ACA products.

To get many more Americans enjoying health cover for their family is a great achievement, but if the rush to sign up millions of new customers in a short period of time creates large swings in policy prices, lower than expected levels of cover, and just a poor general customer experience then it could be a problem for the future of the ACA itself – depending on what happens in the November presidential race.

What do you think about the opportunities and challenges for supporting the ACA marketplace? Leave a comment here or get in touch via my LinkedIn.