PwC:Detailed Profile on Health Insurance Exchange Population Issued

By Rob Starr, Content Manager, Big4.com

Health Insurance Exchanges:  Long on Options; Short on Time is a  new report from PwC’s Health Research Institute (HRI) projecting that more states are likely to involve the federal government than previously expected when it comes to health insurance exchanges. States have two crucial decisions to make this fall that could have a big impact on patient care a decade from now: whether to expand Medicaid coverage and how to create an open insurance marketplace that meets their needs.

Kelly Barnes, PwC US health industries leader comments:

“Newly-created exchanges represent the biggest insurance expansion since Medicare in 1965,” she said.  “The exchanges will serve a group of people who may be purchasing insurance for the first time.  Companies seeking to capture this new customer base must work quickly to understand the distinct needs of this group and develop ways to communicate with them in clear, understandable terms.”

State-based exchanges will create an irreversible shift in the insurance market that ultimately changes the way medical care is sold in the U.S.  For the insurance industry, they represent a major business opportunity –a market that will translate to$205 billion in premiums by 2021.

Uppermost on the minds of many insurers are the issues of pricing and risk selection.  At first, insurers on the exchanges are likely to compete based primarily on price.  However, as exchanges mature, health plans will need to differentiate themselves beyond price to maintain loyalty of existing members and attract new ones.  Because of the distinct health needs of the exchange population, large insurers and Medicaid Managed Care plans that already have experience dealing with the needs of low-income, less-educated populations may have an early advantage.