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Insurance Exchanges Will Open Tuesday to Scrutiny, Confusion

Photo caption:

Photo by Jim Mone

Workers at Minnesota's health care exchange portal prepare for Tuesday's opening day. Insurance coverage purchased through the exchanges won't kick in until Jan. 1, and those seeking immediate coverage on that date have until Dec. 15 to sign up.

Tuesday is a big day for the White House. That's when new health insurance exchanges open in every state, where people can buy the insurance the Affordable Care Act requires next year. They will also see if they qualify for new subsidies to help them afford it.

The day will be met by both intense scrutiny and complete cluelessness. Policy wonks will be watching like scientists running lab rats through a maze.

Camped on the virtual sidewalk outside the new exchanges, just waiting for the online doors to open, are people like Caroline Pearson, a vice president at Avalere Health, a Washington, D.C., consulting firm. She says she knows a lot of people who are just dying to take the federal government's new health insurance shopping system for a spin when it opens Tuesday morning.

"I think that every health care researcher in the country is going to immediately log in to the website -- and hopefully not overwhelm the system and crash the website," she laughs.

Researchers like Pearson want to see if the technology really works. They want to compare prices across the country, know who's buying and how much people are willing to spend. They want demographics, consumer behavior, prices -- data, data, data.

At the other end of the spectrum are the estimated 80 million Americans who say they don't know anything about the law and may not notice at all.

Sarah Kos is trying to get the word out in Colorado. She's one of thousands of people across the country who are getting federal grant money to help people buy insurance on the new marketplaces.

"I went through all their training, knocked it out in a week, so I'm like: Yes!" Kos says. "Now, did I retain all that? I hope so."

Koss recently fired up her PowerPoint slides at the headquarters of Colorado's trucking association. A lot of truckers are independent businesspeople who could potentially benefit from the health care law because they don't get insurance through their jobs.

But only six people showed up.

James Ruder is one. He owns a company that makes wooden shipping pallets.

"And I don't even know what I can legally do and can't at this point," he says.

Ruder is clued in enough to at least start asking questions, but says he still has gaps in what he needs to know about the health care law. One thing he's pretty sure of, though: His employees won't want to spend any money on health insurance.

"They live check to check," he says. "It's just the lifestyle that they're in, and every dollar matters. I just can't even imagine a sacrifice like this."

That sacrifice would be about $40 a month for the lowest-price plan for his lowest-paid worker making $10 an hour, after getting a subsidy. Someone who's making his top-end wage, $15 an hour, would pay a little more.

Subsidized coverage for that worker, plus a spouse and child, would run about $90 a month.

That would be a big expense for Ruder's employees.

"You'd be surprised," he says. "We make a $2 error on their check, they're standing there to have another check cut. They can't even wait till the next week."

Pearson hopes that low-wage workers like Ruder's at least show up and look around once the exchanges open Tuesday.

"The real question is, can you reach the uninsured who have health care needs but haven't been getting coverage before, and get them into the system," she says. "That, I think, is what we really need to focus on to decide if this is successful."

Pearson thinks sicker people, and those worried about their health, will be more motivated to shop on the exchanges, even if they're only making $10 an hour.

"Whether or not you get any of the young, healthy people in, in year one, I think that is a major open question at this point," she says.

Getting young those people in is going to be important. Health insurance will only work if healthy people who don't need much care are paying into the system, to help cover the costs of sicker people who will use a lot of health care.

So expect to see more TV ads featuring young, healthy people feeling really awesome about buying health insurance, like this one from Colorado:

"At Connect for Health Colorado, you can shop, compare, pick and purchase the health plan that's right for you. So what actually happens when dozens of plans compete for your business? You win!"

States and the White House have a lot riding on persuading millions of Americans to buy health insurance. Pearson says they have a little time.

"You've got a few years in which the market can handle a bit of a sicker population, but in order for it to be stable in the long term, you've really need to get those healthy folks in."

That means it will take at least a couple years to know whether Obamacare is going to work. And the exchanges are just one part of the law -- the part that involves getting more people covered. The Affordable Care Act has already started regulating insurance companies - setting a minimum for how much they have to spend on health care.

The law is also creating new pilot programs for doctors, giving them incentives be more efficient, in hopes of saving money and giving better care.

Copyright 2013 NPR. To see more, visit

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