There’s been far less uproar surrounding as open enrollment for the federal exchange nears the end of year two. Still, there are plenty of issues. Last year’s systems meltdown has been replaced by the renewal process this year, said John Gorman, founder and executive chairman of Gorman Health Group, and one of four panelists who spoke Wednesday at Bloomberg BNA’s 2015 Outlook on Health Care in Washington, D.C.

Joel Ario, managing director at Manatt Health Solutions, rated enrollment better this year. The consumer experience was OK, he said, but not great. “Front-end experience has improved substantially,” Ario said, but back-end issues still remain.

Most of the easiest people to sign up for health care have done so, Gorman said. The challenge now is enrolling those whose English is limited and/or who don’t know they’re eligible for subsidies. That’s where brokers can help, Gorman said, as they are a stable and knowledgeable base who can help enroll low-income and underserved individuals.

The long-term goal for is to have a “Google-like experience,” Ario said, where a person inputs information into a search engine and it gives a recommendation for the best plan for that individual. “We will get there eventually,” Ario said.

The Affordable Care Act, too, could use some tweaks, Ario said, but with the new Republican-controlled Congress, bipartisan fixes aren’t likely, he said.

The definition of full-time employees is one example. Ario said a broader discussion on the employer mandate is what’s needed if the goal is to reduce the burden on employers, however, Republicans are focused on increasing the threshold from 30 hours a week to 40, which they know President Obama will veto. Four to five times as many workers could be manipulated below the cap if it were moved to 40 hours a week, Ario said. “It really creates the problem of disruption or makes it worse,” he said.

Also see: “Bill bumping ACA to 40-hour work week passes House

Value jeopardized

Meanwhile, consumers want value — the best coverage at the cheapest price — said Dan Durham, vice president of policy and regulatory affairs at American’s Health Insurance Plans. High-priced specialty drugs and provider consolidation are making that goal more difficult, he said.

When pharmaceutical companies monopolize price, value can’t be delivered, Durham said. Innovation is critical, he said, but so is responsible pricing.

There’s a growing trend of provider consolidation, which hurts competition, Durham said. If health plans can’t negotiate a lower price, they can’t deliver value, he said. Without leverage, Durham said, “you have a significant policy problem.”

Following Medicare’s lead

Since the ACA passed, insurance companies have had to adapt quickly to government-sponsored financing, Gorman said, and he doesn’t anticipate all of them will survive. “There’s going to be a lot of road kill along this highway,” he said.

Many of today’s changes are following Medicare Advantage Plans, Gorman said. Typically, whatever Medicare does, Medicaid and commercial markets follow suit three to five years later, he said.

King v. Burwell

Looking toward the future, in March the Supreme Court will hear arguments in King v. Burwell — and is expected to decide by June whether consumers who sign up for health insurance on the public marketplace can receive premium tax credits in states that have not established their own exchange. Invalidating the rule would have “disastrous” consequences, said Timothy Jost, professor at Washington and Lee University’s School of Law. Health insurance would once again be unaffordable for the people who signed up using those credits, he said, and it would drive prices up for others.

The main issue is the wording of the ACA that says individuals qualify for the tax credits when they buy insurance on a marketplace “established by the state.” Only 14 states have set up their own marketplaces, with the rest, mostly Republican states, relying on the federal exchange.

“The court could rule either way on this case,” Jost said.

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