…Until the Obamacare exchanges, now referred to as “marketplaces” –  are supposedly opening for individuals who seek to purchase comprehensive health plans that will be partially paid for by other taxpayers.  As written and originally intended under the federal health law, taxpayers may only be of assistance to marketplace consumers in states that have established their own marketplaces.

A Washington Post interview with Health and Human Services Secretary Kathleen Sebelius confirms why the exchanges are now called marketplaces:

Sebelius confirmed that the agency has indeed pivoted away from using the word “exchange” to describe the new Web sites that will launch Oct. 1. “What we found as we got closer to developing outreach and marketing materials was it meant very little in English and less in Spanish,” she said. “No one knew what we were talking about.” So, now the Web sites are marketplaces.  

Yesterday marked the first day where people who live in states with federally-facilitated exchanges may sign up to create a personal account – the first step needed to enroll in such marketplaces.  Those who decide to enroll and are willing to pay higher premiums will not be able to compare insurance plans or purchase coverage until the marketplaces go live on October 1.

The success or failure of the Obamacare marketplaces largely depends upon the number of people who sign up.  The Obama administration states that 7 million people are needed to enroll within the next year.  Of this total amount, 2.7 million young invincibles are needed to sign up so that their higher premiums will offset the premiums of the older, sicker populations on the marketplace.

The Obamacare train may derail  if marketplaces in states are not competitive enough.  Some states, including North Carolina, have a minimal number of insurers (three) that have agreed to sell plans within the federal marketplace.  Of North Carolina’s three insurers, only Blue Cross and Blue Shield offers plans covering all of the state’s 100 counties.  Less competition means higher prices.

The St. Louis Post- Dispatch writes on the marketplaces

John Holahan, a fellow at the Urban Institute in Washington, said he anticipated that “there will be vibrant competition, except in the states where ‘the Blues’ (Blue Cross and Blue Shield) are the dominant players. 

In North Carolina, Blue Cross and Blue Shield has over 83% of the individual insurance market.

Even Timothy Jost, Obamacare supporter and health policy expert, says:

“Three applicants is low, but there are other states where that’s true,” said Tim Jost, a health law professor at Washington & Lee University in Virginia. “In North Carolina at this point, you don’t really have a competitive market.”