With 24 Republican senators up for reelection in November 2016, not to mention the presidential election, there is so much set to change for both public and private exchanges.

“Who takes over the Senate and who takes the White House will drive where the market ends up,” said Yvette Fontenot, partner at Washington-based lobbying firm Avenue Solutions, and former deputy director of the Department of Health and Human Services’ Office of Health Reform.

Fontenot, who helped develop the exchanges as a staff member working with the Senate Finance Committee, said Republicans originally didn’t want one national exchange and were set on the idea of multiple competing exchanges. If the Republicans keep the Senate and are in the White House, they are likely to push exchanges back to the state level, she said Wednesday at a health insurance exchange policy conference in Arlington, Va.

Also see: 8 features a broker should look for in a private exchange

Looking at private exchanges, the 2016 election will have a large impact on future taxes. “What Congress and the administration do on health benefit [taxes] will determine if employers stay in the [health care] game,” she said.

Those decisions revolve around conversations currently taking place to repeal the Cadillac Tax, which is set to begin in 2018 and is estimated to bring in $87 billion over 10 years. “These are moving factors decided in the next two to four years that influence which way policy pushes the exchange world,” she explained.

White House

The driving factor behind all the change will be who the next president is. The Obama administration has taken “great latitude in writing regulations and they’ve done things that some say they didn’t have the authority to do,” Fontenot said. “They could all be drawn back.”

The big question that remains is how the administration will treat health savings accounts, which could be eliminated. If they were to be eliminated, “it’s a lot harder to run an exchange if [one doesn’t] have the flexible account to give an employee,” Fontenot said.

Attend EBA's Private Healthcare Exchanges Conference in Chicago July 23-24

All of these changes are currently being “overshadowed” by all in the industry consolidation that has taken place with insurers this summer, Fontenot added.

Despite the changes to come, the exchange concept itself is engrained and consumers are not going to take a step back to where they couldn’t compare products on an apple-to-apple basis and shop for the way they shop for everything else, she said.

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