What will happen next week, when the 51 public health insurance exchanges open for business? In many cases very little.

The October 1 launch of the state-based exchanges, including a separate Web site for the District of Columbia, is clearly an important milestone for U.S. health care reform and the Affordable Care Act, which authorizes the online insurance markets. Public attention has been focused on this date, and there is the very real chance of an embarrassing systems crash or a series of operational miscues that could delay enrollments, generate negative publicity and potentially jeopardize sensitive data.

But while not discounting the impact of these possibilities, even a dramatic mishap or a government shutdown is liable to do little to throw the slow slog toward health care reform wildly off track. In the three-and-a-half years since the passage of the ACA, progress to implement the new law has been lurching and uneven and is liable to remain so in the wake of October 1.

Here’s a rundown of some of the key issues and how they are liable to play out next week:

  • A number of state exchanges will not be fully up and running in time for the deadline. Among them are Colorado and Oregon, as well as the District of Columbia, each of which has enthusiastically embraced the ACA and will operate its own state or district-based exchange.

Oregon, for instance, announced last month that while Cover Oregon, the state’s online insurance marketplace, will open for business on October 1 as planned— the state will limit access to the new website for several weeks to address capacity and security concerns.
State residents will still be able to shop for health plans and to enroll in coverage on Tuesday, but they will need to sit down with a trained agent to log on to the system.

“We want to make sure we don’t overload the system and to make sure we quickly identify and resolve any bugs, but at the same time we want to open October 1," according to a Cover Oregon spokesperson.

  • Initial enrollment on the exchanges will be curtailed by lack of public awareness and confusion.

All employers subject to the Fair Labor Standards Act, for example, are required to inform their employees about the exchanges and the impact they might have on their benefit plans by October 1. Yet, a survey conducted by Aflac last month found that 69% of workers say their employer has yet to communicate any such changes.
"Navigating health care reform is puzzling and challenging for most employers," says Michael Zuna, Aflac executive vice president and chief marketing officer. "And, many companies aren't prepared to comply with the employee notice deadline which is just a few days away.”

Meanwhile in California, the Kaiser Family Foundation reports that most of the state’s uninsured population has heard little about the ACA and the exchanges, and that many uninsured residents are unaware that they are likely to quality for premium subsidies or the state’s newly expanded Medicaid program.

  • Premium levels are likely to be lower and more health plans will be available than has been widely forecast.

A report this week by the Department of Health and Human Services indicates that in the 36 states where the federal government will be responsible for the exchanges consumers will have multiple plans to choose from and premiums will be significantly lower than expected.
According to the report, individuals and families will have an average of 53 plan choices, almost everyone will have a choice of two or more insurance issuers, and the average premium nationally for the second-cheapest silver-tier plan will be $328 a month without a federal premium subsidy — 16% lower than projections based on Congressional Budget Office estimates.

  • Public fears over data privacy and security on the exchanges remains high, and nothing that happens next week is liable to allay those concerns.

With respect to the potential for government privacy violations, 53% of the respondents to a survey released this week by the web site HealthPocket.com were not confident that personal information provided on the exchanges would be treated as private and not shared with other government agencies. In a separate survey by HealthPocket, 57% of the respondents were not confident that personal information requested within the marketplaces would be safe from hacking and other misuse.
"There is a high level of public skepticism regarding the privacy and data security safeguards for the government exchanges," Kev Coleman, Head of Research & Data at HealthPocket, said in a statement.

  • The tax implications of the ACA for employers, insurance carriers and consumers are an on-going source of confusion, and the IRS and other government agencies are still working to clarify them.

Within in the past two weeks, for example, the IRS finally clarified what the ACA will mean for two common corporate benefits: defined contribution plans and flexible spending accounts.
For more about what to expect when the exchanges launch next week see the following: 

Sebelius: ‘We'll be ready on Oct. 1'

Consumers Not Concerned with Major Health Insurers Missing from Exchanges

Latest Poll Finds Confusion, Ignorance over Health Care Reform Still Rampant

CMS: One Hour to Report HIX Security Incidents

Computer Bugs Not Expected to Infest Enrollment

Obama’s Small Business Health Markets Delayed for 1 Month

Don't forget about employee ACA communication due Oct. 1


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