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Editorial: Lost in the Marketplace; Health Consumers Will Need Help

Although key dates are fast approaching under the Affordable Care Act, it’s far from clear to many consumers just how the new health insurance marketplaces mandated by the federal health care reform law will affect them.

In New Hampshire, for instance, a recent online survey of 648 residents — albeit an unscientific one — suggests that the state has a lot of work to do before people begin enrolling in the health insurance marketplace, also called an exchange, on Oct. 1.

For instance, The Associated Press reported recently, one survey participant who plans to retire in July and then secure coverage through the exchange wrote, “I have tried to do my homework but everyone (insurance companies, state insurance reps, my human resources dept.) tells me that they have no information and will not have any until at least October. This leaves me unable to plan.”

That New Hampshire might be lagging in this regard is attributable to the previous Legislature, whose Republican majority displayed its contempt for Obamacare by passing a law forbidding the state from running the health insurance marketplace. This brilliant act of symbolism left the state behind the eight ball when the Supreme Court upheld the law’s constitutionality and also means that the federal government will be running the state’s exchange, although the state will participate as a partner to regulate insurers and provide consumer assistance.

The exchanges will offer individuals and small employers a choice of private health plans that provide coverage in 10 specified categories. The coverage will begin on Jan. 1, when nearly all Americans will be required to carry health insurance or pay a penalty. Those who can’t afford to buy coverage will be eligible for subsidies in the form of tax credits to help.

Pretty clearly, the state needs to undertake a significant citizen education program between now and then just to explain the basic requirements of the law. The survey and much anecdotal evidence suggest that many people are still largely ignorant of their obligations and opportunities under the law.

One key question about this brave new world is how exactly a consumer will shop for policies. Obviously, the potential for confusion in something so complex as health insurance is vast. Experience with the Medicare drug benefit enrollment a few years ago offers a prime example.

So whatever information is available has to be clearly presented and offer easily understood apples-to-apples comparisons. Even if that’s the case, many consumers will need help, in many instances one on one. As to who will provide such help and explain products to consumers, the choices in New Hampshire seem to boil down to insurers themselves or to “navigators” — perhaps representatives of non-profit health advocacy organizations. It’s not clear how insurers could provide the kind of disinterested advice needed to help people make the best choice for themselves, so that’s an issue that needs to be carefully vetted.

Presumably the prime platform on which the exchange will be offered is the Internet, but the state will also need to be mindful of the fact that many people still lack computers or Internet service. Some convenient alternate means of getting access to and evaluating products offered on the health exchange will have to be offered.

The Affordable Care Act provides the best opportunity the nation has ever had to extend health care coverage broadly. But the political realities that allowed it to become law dictated that health care reform would be a hybrid of public and private sector elements. That inherent complexity requires a robust effort to explain to consumers just how they stand to benefit, and to help them make sound choices about coverage. Right now, that may be the most pressing issue related to the law, and all the states need to prepare quickly to play their appointed role.