march toward full implementation continues.
Exchanges – As of today 17 states will create their own
exchange, seven states will partner with the government, and 26 states have
defaulted to the federal program (if anyone asked we would suggest defaulting
in order to let the feds do the early heavy lifting).
most important questions now are:
Will any of
the exchanges be ready on time?
products be affordable?
Employer Response – there is a great deal of discussion
but very few decisions have been announced (although some are likely in place
but not announced).
Will a generally
weak economy and slack labor market play into the decisions? Time will tell.
A strategy of
self-insuring may gain favor, and we will do a separate post on that topic.
Providers – the word heard most often is “chaos.”Providers are trying to prepare for a system
as yet poorly defined. Some trends are emerging (integration, the early ACOs)
but it is too early to tell how anything will work.
primary care and rural health care are likely to be especially acute.
and health care focused lawyers are raking it in – so somebody wins.