Obama Re-Election Clears Uncertainty About Health Insurance Exchanges

The re-election of President Barack Obama lifted most of the remaining uncertainty regarding the implementation of health insurance exchanges under the Affordable Care Act.

With the re-election of President Barack Obama on Nov. 6, the states and software vendors will have more certainty now that Obamacare is here to stay.

Even Republican congressional leaders such as House Speaker John Boehner have acknowledged that the president's re-election ensures that Obamacare will remain "the law of the land."

As a result, the states will need to decide whether to implement health insurance exchanges (HIXes) under the Affordable Care Act—or allow the federal government to do it for them.

HIXes are Web-based marketplaces that allow small businesses or uninsured individuals to purchase health insurance.

States are eyeing a Nov. 16 deadline to set up an HIX under the ACA. Otherwise, the federal government will step in and run the insurance shopping platforms, Mary Scanlon, senior vice president of business development for government health care solutions at Xerox, told eWEEK in an email.

Many states may opt for the federal model, in which the Department of Health and Human Services will run exchanges in states unwilling to create their own, Scanlon noted.

"Individual states could still drag their heels on it if they chose to and say let the federal government run this," Lynne Dunbrack, program director of connected health IT strategies at IDC Health Insights, told eWEEK. "A number of states aren't going to establish a state-run health insurance exchange," she said, noting that some states will turn back the grant money.

In Virginia, Gov. Bob McDonnell has said he will let the federal government run an exchange rather than implement a state-run platform, according to the Washington Post.

Vendors such as Microsoft, Oracle and Xerox are building HIXes for various states.

On June 28, the Supreme Court upheld the ACA by a 5-4 decision, but with Republican presidential nominee Mitt Romney vowing to repeal the legislation, uncertainty lingered.

"The election was the last 'wait and see' event for states, providers and health insurance companies that were holding out to implement certain aspects of reform," said Scanlon. "With 2014 deadlines looming closer than ever, there’s not a minute to lose."

Despite the increased certainty in the development of the exchanges following Obama's re-election, citizens haven’t made up their minds about them, according to a recent study by Harris Interactive. Of the respondents in the survey, 46 percent were unsure if they would use HIXes.

Open enrollment for the exchanges is scheduled to start on Oct. 1, 2013, and coverage needs to take effect on Jan. 1, 2014. Health insurance carriers will need to build their technology systems to integrate their plans in the exchanges.

Unlike HIXes under the ACA, the meaningful-use incentive plan for implementation of electronic health records (EHRs) is a bipartisan issue and unaffected by the election, experts say.

"The incentive program was passed separated from the ACA, and we would expect certainly that the meaningful-use program is going to continue," Mark Segal, vice president of government and industry affairs for GE Healthcare IT, told eWEEK.

The part of the ACA that called for providers to group together to build accountable care organizations (ACOs) is also bipartisan, according to Segal.

"Those kinds of programs really generate demand for health IT, whether it's EHRs, revenue cycle management, or more-effective imaging workflow, interoperability," said Segal. "All of those are really felt to be foundational."

However, the Republicans' plan to repeal Obamacare, which was a prominent issue in the election campaign, has slowed decision making for IT software vendors, said Dr. Mansoor Khan, CEO of DiagnosisOne, a company that offers analytics and clinical decision-support applications.

"Now everybody knows these laws aren't going away, so the market will have to start moving," Khan told eWEEK.

"We'll start seeing the real impact of Obamacare," said Khan. "Between the Supreme Court decision and re-election, it kind of solidifies the [legislation]."

GE's Segal agreed: "Some of the state-level uncertainty will begin to recede as decisions are made around the exchanges."

IT vendors will continue developing software that allows providers to report positive outcomes in treatment, rather than be paid a fee solely for service, Khan noted.

"We've been talking about improving the quality of care, and tools they need at the point of care will allow docs to perform this core function," said Khan.

Real-time alerts in software will help doctors monitor patient outcomes, he noted. Analytics in applications will also allow doctors to identify patients who are at high risk of illness.