So, the big day everyone is waiting for is about to arrive: the exchanges go live. But questions abound. Will new enrollees be sicker, healthier, average? Will they be older than younger? Will bad debt surge or stay about the same? How narrow will the narrow networks be? Will the premiums be affordable? Will enough people pick the high-end policies or go only for the cheaper ones? How many people will simply punt? Nobody knows. So much to speculate about, so little time.
One of the grandest experiments in health care history is about to kick off. And we have a front row seat. In fact, we may be on the playing field. The whole event has been analyzed to the dying breath. But in the end, no one really knows how the American public will react. Everyone is guessing or making educated guesses about what will happen. There's no historical comparison, including Medicare, to fall back on or comparable mass marketing situation — that I can think of — to draw insight from. So here's my take.
• It's here. Americans seem to happily ignore all important events until the time is nigh. People are bombarded with campaign ads for over a year in an election cycle, but then in the last six weeks the wheels begin to turn and they make up their minds. Some information may seep in, but up until that point it is just noise — TV noise. I think of this as just-in-time intellectual capacity. Many uninsured people may be somewhat aware of the Affordable Care Act, heard something about these exchange things, and haven't thought a minute more about it — until now. Now, the questions begin.
• Seeking help. Where will people go to seek advice and information? The same place that they've always gone for health care opinions: friends and family. In some cases, no one in their circle will have experience with actually buying insurance, but they are likely to have opinions on its importance, possibly based on personal experience. The much sought-after healthy 18- to 34-year-olds will undoubtedly head straight for the computer for research and tap into social media for opinions. Public polling shows that as of now very few young people have even heard of "navigators."
• Price point. Many uninsured young people, as well as older people, work low-paying jobs. Many college graduates are saddled with heavy student loan debt. Price is a powerful determinant that cannot be circumnavigated. If you don't have the money, you don't have the money — even with a degree of assistance. And if they do scrape the money together, the lowest priced will be the one picked.
• Say what? Insurance is a complicated transaction. A recent Carnegie Mellon University study found that only 14 percent of respondents understood common insurance terms such as coinsurance, copayments, deductibles and out-of-pocket payments. Here's the kicker: The respondents ranged from 25 to 64 years old and had private health insurance. How well do you think the uninsured are going to fare navigating the bronze, silver, gold and platinum packages without a very basic understanding of how insurance programs are structured? Clearly, people need help.
The AHA, AMA and other physician and hospital groups have joined the Champions for Coverage initiative to spread the word and provide information. A number of websites listed in the cover story provide clear, concise information. And hey, you're a natural to help out. People will remember and appreciate it.
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