Last week, Department of Health and Human Services Secretary Kathleen Sebelius started using the term health insurance marketplaces instead of health insurance exchanges, and critics pounced. For the purposes of this column, I will refer to them the same way the Patient Protection and Affordable Care Act does—health insurance exchanges.
The PPACA-mandated exchanges are due to be up and running by October for open enrollment and the regulations being formulated to help guide their development are still, as one state official put it, "very fluid" just eight months out.
The exchanges are unpopular among Republicans. Nearly every state leaving the planning and operation of the health insurance exchanges is led by a GOP governor. And, it is true that states are not clamoring to run the exchanges on their own or partner with the federal government.
Anti-Obama groups such as FreedomWorks characterize the department's departure from using the term "exchanges" as a desperate attempt to attract states to partner with the federal government on operating health insurance exchanges.
Ed Haislmaier, senior research fellow and the conservative-leaning Heritage Foundation calls it a public relations move. "It's the corporate theory of 'We'll get the dogs to eat the dog food if we change the name of the brand'... this is all PR. That's what's going on here," he says.
HHS shed no light on the subject of why it started calling exchanges marketplaces, pointing only to the January 16 blog post by Sebelius that started the dust up. Sebelius writes: "January is the perfect month for looking forward to new and great things around the corner. I'm feeling that way about the new Health Insurance Marketplace."
For policy wonks and those who follow the industry (myself included), there was a resounding, "huh?" after reading that sentence. But, on closer inspection of previous information released about exchanges by HHS, there were references to the term marketplace to describe the exchanges earlier than January 16. The first one I found was dated from February 2011. In describing the consumer-operated and -oriented plans, the release explains:
"By January 1, 2014, you may be able to buy a CO-OP health plan through a new competitive health care marketplace in your state, called an Affordable Insurance Exchange. You may also be able to buy a CO-OP health plan outside of an Exchange."
Now that information about insurance exchanges is getting out to Americans who will be eligible for coverage, it may be that HHS is trying out the term marketplace to better describe how the exchanges will work. That's the theory of one state working closely with HHS to get its state insurance exchange ready for October.
"I think the [term] marketplace—it may have resonated when we started talking about marketplace assisters," says Rita Landgraf, Delaware's Secretary of the Department of Health and Social Services.
Landgraf is referring to the In-Person Assisters (IPA) the law calls for to help consumers understand the exchanges and their options. Delaware, which will partner with the federal government to run its insurance exchange, is calling its IPAs marketplace assisters.
Landgraf doesn't know why HHS started using the term marketplace, but she says it does do a better job of describing what exchanges are to the average consumer.
"If they're going to call that entity a marketplace assister... what are they assisting? They're assisting that consumer in that marketplace."
It's difficult to say where the public stands on health insurance exchanges. Nebraska attempted to gauge the opinion of its state's residents on the issue through public hearings, but in a letter explaining why the state would opt for a federally run exchange, Governor Dave Heinman wrote that he had heard all sides, and found the issue "polarizing."
Critics, like Haislmaier, say regardless of whether HHS uses marketplace or exchange, it won't change the opinion of detractors.
"I don't think it's going to have much effect, and I don't think it's going to stick. If you go to their website, they're still calling them affordable insurance exchanges," he says.
"There's a large swath of the public who's rightfully distrustful of the whole structure of it, and this is one of the more visible pieces of the structure of the legislation."
Jacqueline Fellows is a contributing writer at HealthLeaders Media.