Future of Obamacare exchanges uncertain as deadline looms

Scott Bowles, a St. Louis-area musician, has spent several years navigating the difficult private health insurance market on his own.

“You have to become an expert,” Bowles said of his experience shopping for insurance for himself and his two school-aged children. “It’s crazy. It’s really hard to understand—there’s so many plans out there.”

Bowles entered the private health insurance market in 2010 when he became a full-time church musician. First, he searched online for health insurance plans. Then he manually compared his potential costs under each one. During the past three years, he changed plans twice, trying to minimize his out-of-pocket expenses for things like his children’s allergy and asthma medications.

Government insurance exchanges, set to take effect Oct. 1, would potentially solve his problem by providing a virtual storefront where individuals can compare and buy private health insurance. A major provision of Obamacare, the exchanges are supposed to roll out three months before the Jan. 1 deadline for most Americans to have health insurance. But the exchanges are fraught with complications and uncertainties, and may make the task even more difficult for people like Bowles.

The fate of Obamacare funding remains uncertain as House Republicans are preparing a Hail Mary pass to defund the health law as part of a larger budget plan that could force a government shutdown if it doesn’t pass by Sept. 30.

Even without the bill’s passage, the Department of Health and Human Services (DHHS) was months behind in testing computer systems that support the exchanges, as of August. A final decision on the security of the government’s data hub for the exchanges won’t be made until Sept. 30, according to a report by the DHHS inspector general.

What insurance options people will find on the exchange also remains unknown.

According to a Reuters report from late August, the DHHS will not have contracts finalized with insurance companies on the exchanges until “mid-September.” With less than two weeks before the exchanges go live, the White House still has not named the insurance companies that have committed to participate or given specifics about the available plans.

Some big insurance companies have publicly shunned the new healthcare marketplaces. In the months leading up to the Oct. 1 roll out, news reports from around the country said insurance giants such as Aetna, United Health Care, and Cigna were withdrawing their applications to participate in some state marketplaces. Insurance companies cited uncertainty in the exchange risk pools and problems negotiating rates as reasons for not participating.

Twenty-seven states have also opted out of setting up their own exchanges, citing high costs and regulations. This leaves the DHHS to set up the online marketplaces in those states. Another seven states asked the DHHS for assistance, leaving only 17 states fully in charge of their own exchanges.

Just how many choices customers on the exchanges will actually have remains to be seen when, and if, they open on Oct. 1.