While the government shutdown has had little, if any, immediate effect on the implementation of the Affordable Care Act — public health care exchanges opened as scheduled on Tuesday — the next looming crisis is the federal debt ceiling, which must be raised by Oct. 17 if the country is to continue meeting its financial obligations.

Speaking during a panel discussion at last week’s Benefits Forum & Expo, Gretchen Young, senior vice president of health policy with the ERISA Industry Committee, addressed Republicans’ attempts to delay the individual mandate as a way to get the debt ceiling raised.

“What they’re talking about is having a delay to the individual mandate, in order to get that debt ceiling raised,” she said. “That will actually, I think, probably take down most of the Affordable Care Act.”

Young, along with fellow panelists Paul Fronstin, director of the health research and education program with the Employee Benefit Research Institute and Michael L. Millenson, president of Health Quality Advisors LLC, discussed several issues relating to the ACA, including the much-anticipated launch of the public health care exchanges.

Citing a general lack of confidence in public exchanges, Fronstin said private exchanges may offer employers a middle ground between abandoning employer-sponsored coverage completely and staying in the health care coverage business.

“If we drop the term 'exchange', we would just be saying it's a way for employers to offer their employees more choices,” he said, adding that employers have been interested in the concept of private exchanges for a very long time.

“Maybe the Affordable Care Act is the reason why we're talking about it now. … Maybe the technology finally caught up to the concept, which is what's allowing it to happen,” he said. 

The ACA still faces legal challenges, said Young, referring to lawsuits over the contraceptive mandate that could end up before the Supreme Court. “Whichever way they go will be interesting, but it won't take down the Affordable Care Act,” she said.

Changes brought about by the ACA “threaten” what benefits professionals do, said Millenson. “Whether that threat turns into opportunity is really based on your knowledge,” he said, and emphasized the law is “a professional opportunity to make a difference for your company and for your workers that, literally, has not come along since World War II.”

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