It's all about the dollars. And the change.

On March 23, 3010, President Obama signed the Affordable Care Act, a law allowing comprehensive health care reform to roll out over several years.  We have already seen a number of these changes influence public and private insurance, with many more policy changes to come.  Good or bad, we are experiencing a complete overall of the healthcare industry as we know it.   Perhaps the gradual changes allow us to steadily adapt instead of throwing us into the deep end of the reform pool.  All of these alterations appear to be building up to the backbone of the health reform laws – The Health Insurance Exchanges.

Mandated to be in place by January 1, 2014, these state-based health insurance marketplaces will be enrolling 32 million of the 50 million Americans who, at present, do not have health coverage.  The exchanges represent a grand plan to make health insurance accessible and affordable to those who now struggle to find and keep coverage.  Individual consumers and small business will be able to shop online for competitively priced coverage, and many will receive government subsidies to help pay premiums or be granted tax credits.

According to a recent study, 44 percent of employers believe they will provide employee health benefits through a corporate exchange in the next three to five years, although 72 percent declared they are “very or somewhat interested” in exploring corporate exchange models.  To give employers power in numbers many are trying to create a group purchasing option to negotiate lower rates from the insurers.  Corporate or private exchanges solicit group-specific insured rates while the employer determines the contribution for employees to use in purchasing coverage.  The employee then makes their final decision about coverage.  In the same study, 86 percent voted that the ability to reduce costs was the most important feature of a corporate exchange.    

States will be submitting their “Exchange Blueprint” for approval in 2013, but if a state hasn’t made much progress, the federal government can intervene and make the final decisions.  The Obama administration's request for $800 million to operate federal exchanges has gotten a frosty reception from congressional Republicans.  For things to go smoothly, state and federal officials must work together to verify private personal and financial details for millions of people, make sure that consumers are enrolled in the right health plan, and accurately calculate how much government aid, if any, each household is entitled to.

The White House is giving states some flexibility in setting standards for their marketplace, as the state gets to decide who runs the new market and which insurance companies get to participate, however Health and Human Services will certify which exchanges are – and are not – able to deliver the customer experience that the White House wants to see, including things like allowing consumers to easily compare plans and having an enrollment mechanism for both private insurance and Medicaid.

The Affordable Care Act assigns most Americans a legal responsibility to carry health insurance, either through their employer, a government program or by buying their own.  Millions will receive financial assistance for their premiums.  Whether that amounts to an unconstitutional expansion of federal power, as a group of Republican governors allege, is among the subjects of a showdown that began March 26 when the Supreme Court heard three days of arguments.  A decision is expected by June.