There has been so much focus on the public exchanges since their launch Oct. 1, but they can’t be looked at in isolation, said Avalere Health’s Elizabeth Carpenter during a session this week at the International Foundation of Employee Benefit Plans’ annual conference. Important insurance market reforms must be taken into consideration as well, she said.

“We can’t focus just on the exchanges, but also on the broader health care system and how things are evolving – the idea that on January 1, 2014, everyone can buy health insurance on a guaranteed issue basis, that there will be no pre-existing condition exclusions, that premiums will not vary based on your health status,” said Carpenter, a senior manager with Avalere Health. “That’s a huge change in the health industry and something that’s going on in conjunction with health insurance exchange implementation.”

Acknowledging the interface between the federally facilitated exchange and the insurance carriers is not going smoothly, and that the federal exchange problems are due to more than just volume, Carpenter said no one really anticipated that the federal government would be so heavily involved in as many states as it is currently.

“When this law was passed, no one – not even the most liberal policy analyst – would have thought, or, frankly, would have wanted the federal government to run an exchange in as many states as they’re running one,” she said. “Very few people anticipated the federal government was going to be shouldering the burden and the level of involvement that they are today.”

Carpenter said the Obama administration has started to lay the groundwork for pushing more paper applications. “You’re going to hear a whole bunch about ‘the Affordable Care Act is more than a website,’” she said. “And they’re going to push that not just from the perspective of these market reforms, but also that there are other ways, in theory, to sign up for coverage other than the website – there are call centers, navigators and other in-person assisters that can help people fill out an application.”

However, she continued, “there’s not a ton of transparency about what happens if you fill out a paper application how you’re communicated with after, but I do know and can say that some of the contracts that were implemented on the federal level – there was a component for processing paper. … there is the capacity, sitting within the federal government right now, to process paper applications if they decide to make that move.”

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