Will ACA’s Exchanges Work?

A new study in Health Affairs has Aaron Carroll worrying about their ability to bring down costs:

This study looked at people in Massachusetts’ health exchange and asked them about the issues they face due to health care costs. They found that 38% of patients reported a “financial burden,” defined as having problems paying medical bills, having to set up a payment plan to pay medical bills, or having trouble paying for things like food, heat, or rent because of medical bills. They also found that 45% of people reported higher-than-expected out-of-pocket costs for health care. This isn’t great news. It means that a significant number of people are still finding health care costs to be a real problem. It gets worse, though. Families with more children had more problems. So did families who make less than 400% of the federal poverty line.

Christine Vestal fears a lack of competition:

Health economists predict that in states that already have robust competition among insurance companies—states such as Colorado, Minnesota and Oregon—the exchanges are likely to stimulate more. But according to Linda Blumberg of the Urban Institute, “There are still going to be states with virtual monopolies.” Currently Alabama, Hawaii, Michigan, Delaware, Alaska, North Dakota, South Carolina, Rhode Island, Wyoming and Nebraska all are dominated by a single insurance company. The advent of the exchanges is unlikely to change that, according to Blumberg. …

[I]t is unclear how many insurance carriers will decide to seek approval for selling their products through these online marketplaces. Insurance companies have been mostly silent about their plans, with some citing uncertainty about federal and state rules as a reason for holding back.