The main event for Obamacare, federal health reform, will be the establishment of exchanges, where people will be able to look for health insurance and is the only place where plans can purchased with premium subsidies. For the folks between Medicaid eligibility and 250% FPL (federal poverty level), where the insureds will not only received premium subsidies but also cost sharing subsidies, the opportunity for coverage will likely be significant …….. or will it.

Since these ideas were first floated, I have speculated that even with subsidies, many of the plans inside these exchanges will be so expensive that the costs to applicants will vary little from today’s costs, if at all. Certainly for higher incomes, where premiums scale off, the opportunities will be less.

For years, those of us who have brokered health insurance policies have regularly encountered people earning in the ranges above Medicare to 300% FPL who voluntarily have decided not to purchase coverage. These people are not always the “invincibles” in the 18-34 year old range either. In fact, we have often noted that those eligible for Medicaid often do not sign up for coverage even though nearly all of their costs are taken care by government programs.

The Kaiser Family Foundation, in its Kaiser Health News, has made note of this situation on this edition of their newsletter::

Few have been rash enough to predict universal enrollment in the reformed health insurance market, but might the circumstances alluded to in the Kaiser article portend even rougher sledding for success of the reforms?