"Adverse selection is a huge issue," Zirkelbach told HealthLeaders Media. "The broad agreement is that for the new exchanges to work there needs to be broad participation among young healthy people to offset the cost of those who are older and have high healthcare costs. That is why our industry has been so focused on the issue of affordability. If it is not affordable and young healthy people decide not to purchase, these exchanges won't work."
Zirkelbach says the uncertainty will be mitigated somewhat by federal backstops such as a three-year reinsurance program that is designed to temporarily offset highest-cost enrollees and provide some stability for the plans in the start-up phase.
While there are bound to be glitches when the enrollment period begins, Zirkelbach says many of the plans that will participate in the exchanges have gained relevant experience with the launch of the Medicare Part B program.
"Obviously the exchanges are larger, but when the Medicare Part B program was implemented there were problems, and it was our members who stepped up and helped fix problems while at the same time helping seniors navigate the system to find the right kind of drug coverage," he says. "That is the role we are going to play in the open enrollment for new exchanges."
Also today, the Department of Health and Human Services released a report finding that consumers in most states will be able to choose from an average of 53 health plans in the exchanges, and that most will have a choice of at least two different insurers or more. Premiums nationwide will be around 16% lower than originally expected—with 95% of the eligible uninsured living in states with lower-than-expected premiums—even before taking into account financial assistance.