After two years of health plan enrollments in the emerging online marketplace, it’s possible that public and private exchanges are finally converging.

One industry observer says crunched numbers from 2015 public-exchange enrollments suggest that U.S. health care consumers not only are more comfortable with the emerging online marketplace than expected and weren’t swayed by political arguments, but their behavior also validates well-established attempts by employers to bend the cost curve.

Among some of the noteworthy developments supporting this view:

  • More than half of HIX enrollees were confident enough to make a new health plan selection after the initial open-enrollment period.
  • The number of plans offered soared 40% from between 2014 and 2015, while bronze and silver offerings nearly doubled and 70 new entities participated in the exchanges.
  • Significantly low rates were offered by plans that were new in 2015 or did not fare well in 2014 as part of a strategy to undercut HIX market leaders.

The latest government figures also demonstrate that “the long predicted move to defined contribution methods for employer-based health care is a fact merely waiting for recognition, action and modest maturation of the exchange portals,” writes John Kelly, principal business adviser at Edifecs, in Government Health IT. “Future success will depend on the ability of health plans to handle the transition.”

Also see: Transition to private exchanges could be easier than expected

He also predicts that exchanges and third parties increasingly will cater “to an emerging consumer category” during the 2016 enrollment season. Kelly’s article is generating plenty of food for thought.

As with most projects or significant changes in any market, “the second year is easier than the first,” observes Robert Booz, a health care analyst with technology consultant Gartner. “The bigger question is will it be a sustainable enrollment year-over-year that attains the results of better coverage?” 

Larry McNeely, policy director for the National Coalition on Health Care, says “the exchanges are delivering, in this respect, on the founding premise of increased competition and choice for consumers, and that consumers are availing themselves of that.”

Henry J. Aaron, a senior fellow with the Brookings Institution, notes that “after an exceedingly rough beginning, the people managing the federal exchange pulled up their socks and solved their major problems. … In the states, it’s been a very mixed bag. None has been free of serious challenges, but most of the states have managed, one way or another, to surmount them.”

Also see: Employers committed to health benefits, despite cost fears

One big surprise for Aaron was “the dog that didn’t bark” – a scenario in which any discontentment from HIX enrollees who received more tax credits than to which they were entitled based on their full-year income was insignificant. “I think it’s quite remarkable,” he says.

Booz believes that health plans participating in public exchanges may consider focusing more resources on compliance, as well as “investing in flexible architectures and applications.”

An unintended consequence of consumer ease with altering their coverage in the exchanges is the danger of undermining clinically integrated plans and their ability to manage individual care, according to McNeely.

“I think a lot of these plans aren’t necessarily as engaged as some of the real market leaders are in care management,” he says. “So if I switch insurers but keep the same doctor or providers, then I can continue to be managed across time. It’s just an interesting wrinkle.”

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