News Feature | August 8, 2013

Significant Hurdles Loom For HIXs

Source: Health IT Outcomes
Greg Bengel

By Greg Bengel, contributing writer

HIX

Insuring young people, understanding the data hub, and navigation all present problems for HIX implementation

With the launch date for both state-based and federally-run health insurance exchanges (HIXs) drawing nearer, there is plenty of debate as to whether or not the implementation will be a success. In light of this, Government Health IT published an article laying out three obstacles to success that HIXs will face.

The first obstacle, says Government Health IT, is that young people often choose to be uninsured. Looking at California and Texas specifically, the article says that “enrolling young people who broadly fall into the category of the working poor or lower-middle class, not offered insurance with their jobs, or working part-time, seasonally or as a freelancer” is a big challenge. HIXs, it says, make financial sense for people who are treated regularly and already buying their own or their family’s plans. But when it comes to the nation’s young, who do not use healthcare regularly, HIXs might look like a bad deal compared to the $95 dollar penalty they would get in the first year if they don’t participate.

Looking at California and Texas again, Government Health IT says if many young people go uninsured, “the state exchange markets may see rising costs, a problem for exchange organizations operating on slim budgets and counting on enrollments.”

This concern is widely echoed. An article from thebaynet.com discusses a recent healthcare provider forum conducted by U.S. Senator Ben Cardin and Representative Steny Hoyer. Providers highlighted the importance of communicating and marketing HIXs to young people, who they say often feel invincible. Providers feel that young people need to know they are not impervious from financially devastating illnesses.

CMS would agree. In their recent analysis, they list young people as one of six groups of uninsured people that are critical to the success of the new health laws.

The second obstacle, according to Government Health IT, is federal data management troubles. The federal data hub will be “a sort of highway that supports all of the exchanges in what should be real time,” rather than an actual database. However, due to the short amount of time given to building the HIXs, there are gaps that won’t be filled until after enrollment. The ones so far are relatively minor enough that they are unlikely to impact the experience for consumers, but experts warn that there may only be more problems.

An article on governing.com goes into greater detail on the challenges of the federal data hub. According to the article, seven states in a recent GAO report identified the hub as their major operational challenge. Check out the GAO report here.

The third obstacle presented by Government Health IT is that, “Insurance navigation falls short.” The article says that online, phone, and in-person consumer assistance programs will be vital in compelling consumer enrollment. “If enrollees aren’t able to understand health plan details through online information, brokers, navigators, or consumer call centers, they may end up getting bills they don’t understand or agree with, thereby setting up disputes with insurers that may involve exchange ombudspersons, and possibly dissuading people from enrolling the following year,” the article says.