In the language of American health reform, “exchange” and “marketplace” have been pretty much interchangeable. Now, though, the Department of Health and Human Services is embracing the word marketplace in official communications, as part of a revamped public outreach effort.
Eagle-eyed Beltway media outlets like The Hill spotted the PR switch, coming amid lingering political opposition to the Affordable Care Act and as HHS prepares to operate federally-facilitated health insurance exchanges in 31 states.
Following the expectations of ACA drafters, HHS officials thought the agency would mostly be financially supporting and regulating state-based exchanges — not operating dozens of them and building so many in such a short span of time.
There’s about a month left for states to choose a state-federal partnership exchange, if governors and legislatures from the 31 states set to have federal-exchanges want to share some of the IT, regulatory and outreach work.
Whether or not HHS’s exchange-marketplace rebranding will garner the support of reluctant state lawmakers, as October 2013 enrollment approaches, some health policy analysts do think the word marketplace is a better descriptor for communicating with average Americans, like those who’ll be buying insurance with premium assistance.
“The target here is not to make states change,” Alan Weil, executive director of the National Academy of State Health Policy, told The Hill. “I do think they have come to the realization that the term ‘exchange’ does not actually communicate much to the average citizen.”
Exchange and marketplace have been interchangeable prior to the ACA, although “exchange” appears in the ACA 335 times, while the word marketplace is never mentioned, and indeed the acronym HIX has become pretty useful for industry workers.
Other publicly-created exchanges haven’t been so clear cut. The Utah small business exchange, now called Avenue H, sees no mention of exchange or marketplace in its establishing law, instead mandating the creation of an Internet portal for selling health plans.
Florida Health Choices, a small business exchange created by the legislature in 2009 (and spearheaded by then Republican House Speaker Marco Rubio), is dubbed a marketplace, with its statute referring only to an “exchange process.”
In an FAQ on Florida Health Choices’ website, one question asks, “Is this the same as the 'health exchanges' being mandated by the federal government?”
“The Marketplace is not the same as a ‘health exchange,’” the website reads. “There are no mandates as to the products and plans that an insurer is allowed to offer, and there are no requirements for a small business to participate.”