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Obamacare and the Healthcare Exhanges - Current and Future Measures of Success

The next several months will be interesting to watch as people attempt to sign up for insurance and learn about the coverages and costs. While this activity will provide important information about the technical process of obtaining insurance for millions more American citizens who don't have insurance, the complete picture of success or failure will not be clear for years to come. So, what will be the critical measures of success or failure now and in the future?

  1. Who will sign up, and what will they do? The demographics of the newly insured will be very important to track now and in the future. With 7 million new people expected to buy insurance in 2014, the key indicators will be in the continuity of coverage and utilization statistics. Will the most ill people sign up and continue coverage? Will healthy people who are mandated to buy coverage opt out after a few months or pay penalties to satisfy their obligations under the law?
  2. Will current benefits and costs undermine the program? Buyers will be able to clearly see the premium differences between all of the plans, however they may not be able to determine the final costs until they use the insurance. Will they be able to afford the insurance if they have high utilization? Will the utilization rates be initially higher, then taper off as people become aware of costs and how to better care for themselves without healthcare providers. Will the chronically ill new buyers swamp the system with higher than expected utilization and costs?
  3. How will the first few years' experience effect future premiums? The health insurance actuaries have estimated that the first year premiums have been based upon current demographics and utilization in the regional areas of healthcare delivery. Insurance companies and their actuaries will only have a few months experience to determine the rates for 2015, which means that the earliest indication of a future rate structure will be the premiums in 2016. Will insurance companies have appropriate staff for managing outcomes of new insured individuals and families? Will healthcare providers be using lower cost methods of care?

The answers to some of these questions will help to determine the success or failure of insurance exchanges around the country, and will help shape Obamacare now and in the future.

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