The slow 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).
Perhaps the most important questions now are:
Will any of the exchanges be ready on time?
Will the products be affordable?
How will employers respond?
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.
Issues in primary care and rural health care are likely to be especially acute.
Consultants and health care focused lawyers are raking it in – so somebody wins.