95% of Health Care Pros Plan to Join a Health Insurance Exchange

2014 could be one of the largest open enrollments in history.

Insurance Networking News, February 27, 2013

Chris McMahon


More than 95 percent of senior health care professionals plan to participate in at least one health insurance exchange (HIX), according to “HIX Insights from the 

2013 Healthcare Mandate Summit,” a study from Edifecs Inc. And 80 percent plan to join one in 2014. The Congressional Budget Office projected that as many as 12 million Americans would buy health insurance through a HIX in 2014.

“The message we heard from Summit attendees is that while compliance with mandates such as Health Insurance Exchanges is no easy feat, there are considerable benefits to be gained, including increased member enrollment,” said Jamie Gier, VP of corporate marketing for Edifecs. “The value of the Healthcare Mandate Summit was in helping healthcare organizations confirm whether they are on the right path toward compliance and where they can improve. And as the results of the survey demonstrate, many health insurers are embracing the opportunities that exchanges can provide.”

The survey also found skepticism that state and federal exchanges will be ready by the mandated Oct. 1, 2013 deadline. Respondents also are concerned about potential disruptions to current IT infrastructures, the difficulties of reconciling premiums, enrollments and payment records from the HIXs.

HIXs are essential to the effectiveness of the Affordable Care Act (ACA), healthcare industry experts said, because they offer an online marketplace where consumers can shop for, compare and purchase health insurance.

According to Edifecs, the upside potential for health insurers participating in a HIX is significant. The anticipated 12 million people who would buy insurance through a HIX in 2014 would pay a total of $60 billion in premiums, according to a PwC Health Research Institute dated November 2011, which could grow to 28 million consumers paying $200 billion in premiums by 2019.

Report highlights:

• 80 percent plan to participate on an exchange in 2014, which is expected to be one of the largest open enrollments in history.

• 70 percent are “very confident” or “somewhat confident” their organization would be ready

• 69 percent rated the quality of information sharing and collaboration among health insurers and the HIXs they plan to join as “poor” or “very poor”

• 93 percent expressed a strong desire for exchanges to solicit input from them on how to define and operate their enrollment processes

• 31 percent said they plan to participate on three to five exchanges

• 15 percent plan to participate on more than eight

Health insurers are more concerned about the challenges of operating on an exchange than the process of actually joining one, Edifecs said. States have considerable leeway in how they will run exchanges, meaning health insurers operating on multiple state exchanges must support multiple exchange formats, adding levels of complexity.

The Edifecs report includes responses from more than 125 senior healthcare professionals who attended the 2013 Healthcare Mandate Summit, which that took place in early February.

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