As the new math of the Affordable Care Act plays out, insurers and hospitals are scrambling to take advantage of new markets. One of the cornerstones of the ACA was the acquisition of a young demographic from a currently underserved population. There will be substantial fanfare around the country to engage the millions of uninsured or under-insured youth. The projected savings associated with the ACA are contingent upon a large block of younger, healthier participants.
As statewide insurance exchanges develop, insurers are working closely with hospital systems around the country to design local plans that funnel patients to participating facilities. The gain for local hospitals is a new market for guaranteed reimbursement, while the downside is negotiating reimbursements that make economic sense. As reimbursements are hammered out, they will wind up somewhere between current Medicare rates and commercial rates. This is an extremely difficult balancing act, as the outcome will have an enormous impact on the future cost of healthcare nationally. If the participants in these plans have a large swath of younger, healthier adults, the reimbursement figures could remain reasonable for the profitable operation of the healthcare entity, and continued reasonable rates within the statewide exchanges.
If these pools are more heavily weighted toward older, less healthy adults, reimbursements will rapidly rise, creating an imbalance between the expected savings within the system, and the true market cost of the plans. For the good of the country, lets hope for significant participation by younger adults!