Who It Impacts

Regardless of where you stand on healthcare reform legislation, it will clearly make a big impact on America’s health system. Passing and implementing legislation is one thing – understanding what to do and the effects it may have on yourself, your hospital, your business, your employees or your insurance company is quite another.


Below we’ve provided an overview of all of the participants and how the Marketplace will effect them.


From the perspective of hospitals, patients with commercial health insurance typically provide greater reimbursement than with government-sponsored coverage, including Medicare and Medicaid. So the expansion of the number of individuals with commercial insurance gained through insurances exchanges should have positive implications for the industry in general.

As this law kicks in, a drop in the number of uninsured patients could result in a significant reduction in a hospital's charity caseload as well as bad debt.

Health Insurance Marketplace - Impact on Providers (Hospitals and other healthcare providers):

  • As the Marketplace develops, providers should benefit by having more competition from more insurance carriers participating in the Marketplace
  • Moving patients from uninsured to insured will structurally increase provider compensation for services rendered
  • Providers will be faced with a tremendous administrative burden in advising unaware, unprepared or uneducated patients at the time of service
  • Providers currently have demographic data that will allow outreach to be simple and efficient
  • Health Insurance enrollment personnel (i.e. Navigators / Certified Applications Counselors) must be trained and certified


Health reform will affect every American because the new health law establishes new consumer protections and responsibilities. The law is designed to maintain today’s job-based private insurance system and the Medicare system for those over age 65 or those permanently disabled. Most importantly, it provides new ways to obtain health insurance.

Health Insurance Marketplace - Impact on Patients (Consumers):

  • As of January 1, 2014, Americans who can afford coverage will be required to purchase health insurance
  • Health insurance coverage will be made available through online health insurance Marketplace exchanges
  • These exchanges are geared towards providing consumers choices in coverage
  • There will be a better way to compare and purchase health plans offered by private insurers
  • There will be choices among plans with higher or lower deductibles and copays, and higher or lower premiums.
  • A streamlined “One-Stop” process lets the patient complete one application to find out if they qualify for premium discounts, out-of-pocket expense subsidies or Medicare & Medicaid

Insurance Companies:

The Marketplace will provide transparency in level, cost, quality and other important aspects of coverage. This increased competitive health insurance landscape will allow small businesses and individuals to interact with insurance companies on more of a retail-based platform.

According to CMS, the competitive nature of a Marketplace concept alone should help lower health overall insurance costs.

Health Insurance Marketplace - Impact on Insurers (Insurance Companies):

  • The Marketplace is established to foster competition that benefits the consumer
  • HIX is designed and will be executed as an online Internet system
  • Brokers may find themselves on the outside looking in
  • On-boarding and administrative functions will be different than they are today
  • There will be effects that occur that will change their standard operating procedures
There is significant concern that the first years of the Marketplace will only be inhabited by the very sickest applicants, resulting in significant financial losses for the insurance companies.

"When the ACA was passed in 2010, many of us knew what an incredible landmark piece of legislation it was - we simply had no real clue how much it would impact every facet of healthcare delivery, from consumers to employers to payers to providers to the government agencies. As the final lynchpin is put into place starting on October 1, 2013, everyone will be affected by the opening of the Health Insurance Exchanges."

- Susan Aaron