The polarizing effects of the Affordable Care Act have become even sharper since the launch of public health insurance purchasing exchanges on Oct. 1.

Those effects were highlighted by a panel of experts convened by Employee Benefit News for a web seminar titled, “It’s Oct. 2, Now What? Catching Up on ACA Implementation.”

Some of the conflicts center around the search for evidence that public exchange rates present either a great bargain for individuals, or no savings at all. However, explorers have found wide rate variations not only from state to state, but within state. For example, a 35 year-old male nonsmoker from Massachusetts shopping for an entry-level Bronze Plan was found to have options ranging from $192.66 a month to $375.83. Nearby Connecticut, in comparison, had premiums start higher for this applicant profile but cap at a lower ceiling with a premium range of $241.85 to $299.93.

Moreover, anyone attempting to gauge what kind of bargains are available through the exchanges should ensure they are making like comparisons, according to web seminar panelist Rodger Bayne, president of Benefit Indemnity Corporation. “Quotes might be cheaper because of the Bronze rates, with lower premiums but higher out-of-pocket costs,” he observed. “Certainly there will be some disputed claims and concerns about what’s best.”

Other envisioned conflicts stem from lack of employer compliance with employee notification requirements. These could arise if, for example, an employee without coverage receives medical treatment from a provider who might then be on the hook for uncompensated care. If that provider discovers the employee was not properly notified about the exchanges and his coverage options, there could be the makings of a lawsuit.

“We believe that, over time, providers holding bad debt will join with employees and that this will become a civil court issue,” according to Randy Spicer, health services consultant for the National Restaurant Association. To help members comply with ACA notifications and avoid such liability, the association has created an online Compliance Portal which assists with notification delivery and recordkeeping. The group is also exploring whether to make the Portal available to non-member organizations.

On other fronts, attorney Anusha Rasalingam, a partner with Friedman & Wolf, notes that Obama administration rulings on ACA implementation have alienated labor unions. At issue is the status of multiemployer plans as qualified health plans on the exchanges. If multiemployer plans had QHP status, labor supporters say, they could help lower-income and part-time workers retain their existing coverage and cover more costs. However, efforts to have multiemployer plans included in the exchanges were rejected last month by the Labor Department and Department of Health and Human Services.

As a result, “It’s an unusual situation of strange bedfellows, where unions and many Republicans [in Congress] share discontent with the ACA,” Rasalingam said.

Clearly, many questions remain about the ultimate success or failure of public exhanges. But Bayne points out it’s much too early to judge.

“The first day is never going to be the measure,” he said. “There were bound to be glitches at first, but we will learn much more in coming months as demand plateaus. The question will be how many people actually enroll.”

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