1. Look at the technology. It’s incredibly complex and it may not work come “go-live” on Oct. 1. Health exchanges have to communicate with the federal data hub. That system has been spotty. It’s supposed to give income data and confirm citizenship. Exchange systems also must communicate with Medicaid systems, which are different in every state. In Colorado, the Medicaid computer system is an old one that has never worked well. The concept of getting real-time insurance quotes and instant estimates of tax subsidies may be fiction.

2. Contingency plans: If your state is building an exchange, ask about their contingency plans. If states have to deploy these, they could be interesting and expensive.

3. How much is the exchange costing? States that are doing their own exchanges have gotten big federal grants worth hundreds of millions of dollars. It’s always worth taking a look at how much your state is spending to enable private health insurance companies to sell to more people.

4. Who will be left out? In Colorado, we have a big population of uninsured people and a large number of Latino immigrants. Those who are undocumented won’t be eligible to shop on the exchange. What will happen to them? What about others who find coverage too expensive or choose to opt out?

5. Young people. Insurance companies and exchanges will be marketing to young, healthy people. Look for insurance drives on college campuses, etc. These young people are cheap to cover and having them in the risk pool helps cover the really sick people. Between coverage on exchanges and coverage through their parents’ health plans, young people are hot.

6. Are exchanges succeeding? The whole purpose of exchanges is to give more people access to affordable health insurance. Every exchange (state or federal) will be tracking numbers on a daily basis. Compare how many people your state (or the feds) promised to cover and how many are actually signing up. Also take note of what they are buying. Are the cheapest plans the hot sellers? Are most people opting for catastrophic coverage or the most expensive “platinum” plans?

7. What are exchanges anyway?  Most people don’t have a clue what they are. In our state, the exchange is called Connect for Health Colorado. People don’t seem to make any connection between this entity and Health Policy. The same may be true where you live.

Feel free to check out coverage on the Solutions website. You’ll hear that Colorado is leading the pack on exchanges, but our exchange managers and Medicaid folks have been sparring behind the scenes. We learned that they needed a mediator and the Robert Wood Johnson Foundation provided one. (Mediator to triage health exchange problems)

The latest news this week is that we’re seven weeks out and the Medicaid portal isn’t working properly and is spitting out errors. Tech errors prompt red light warning for exchange)

Two sources who have really helped me over the past several months are consultants who are tracking exchanges:

• Caroline Pearson of Avalere Health, at CPearson@AvalereHealth.net

• And after a great session on exchanges in March at the AHCJ conference in Boston, I found Dan Schuyler with Leavitt Partners who was able to talk about exchanges and technology. (Tech troubles could hobble health exchange.) Reach Dan at Dan.schuyler@leavittpartners.com.