One of the major facets of the Affordable Care Act was the health insurance exchanges, and this may be one area upended by the new administration. However, it is also likely that the concept will remain, as it is a common component of several current reform ideas. Much of the recent news about the exchanges has highlighted withdrawals by high profile insurers such as Aetna and UnitedHealth. Other insurers, however, are finding profits and expanding. An analysis today in the New England Journal of Medicine looks at the differences between those who left, and those who are staying. Although a simplification, large plans covering mostly self-insured employers serve mostly administrative functions and have less experience in assessing risk and providing services for low-income populations. These plans tended to withdraw. Insurers with experience in Medicaid managed-care markets have been successful in the marketplace and are expanding. Some companies withdrawing, some expanding seem like the expected activities in a new competitive marketplace. And that is something that both sides of the present healthcare debate should support.
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