Obamacare without the government? We may see it soon

Is Obamacare without the government still Obamacare?

The centerpiece of the law is the insurance exchanges run by the states and the federal government. They offer individual policies to everyone, regardless of health status. This has brought coverage to millions of people who had previously found it impossible to obtain.

Obamacare opponents have no shortage of criticism for the exchanges as large and inefficient new government bureaucracies. They often point to the difficult rollout last fall of the federal exchange website, healthcare.gov, as evidence of the problems.

But do insurance exchanges have to be government-run? Could they operate in another way?

The answer is that they not only could - they already do. Exchanges that are run privately play the same role as public exchanges but with no government involvement. They allow people to shop for and compare insurance policies through websites. Employers can use them to offer their workers an array of choices without providing the coverage directly.

The concept of private exchanges predates Obamacare. But as that law has raised public awareness of the exchange model, major benefits consulting firms have been encouraging employers to try them. The policies the exchanges offer must comply with ACA coverage requirements, but the government has no direct role in overseeing their operation.

A recent report by the consulting firm Accenture predicts rapid growth for private exchanges over the next several years. By 2018, the report sees them covering 40 million people, which is nine million more than they see in public exchanges.

A recent post in the blog of the journal Health Affairs warns of some risks. While larger employers will be able to bargain with insurers for more generous offerings on their exchanges, smaller employers, with less bargaining clout, may have to present their workers with stingier options. But large companies already tend to offer better coverage than smaller ones.

The growth of private exchanges has yet to begin. However, they are clearly attracting increasing attention. And with them, the core concept of Obamacare may spread in some unexpected ways.

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