Will exchanges open to pin-drop silence?

Do you ever get really excited to try out that new restaurant in your neighborhood only to get there and be the only people occupying a table? It's happened to me several times, and yes, it's awkward. While I don't mind eating without crowds all around me, the ability to hear a pin drop in the dining area of a restaurant isn't exactly the ambiance I'm looking for--and it certainly isn't the atmosphere toward which restaurant owners are striving.

I feel badly for these restaurant owners who have poured their heart and soul, and oftentimes a large chunk of money, into realizing this grand goal to open their very own business, only to see it flop.

The situation inevitably reminds me of how the opening of the health insurance exchanges might look like on Tuesday. There's been advertising, outreach, political hype and public opposition. But multiple surveys all show the majority of the American population knows little to nothing about these new online marketplaces, leading me to believe exchanges' grand opening will resemble that awkward dining experience instead of, say, the popularity of an Apple store amid the launch of a new iPhone.

Most likely, enrollment in the exchanges will start very slowly primarily because the plans aren't effective until January, so most consumers will delay purchasing a policy until the last minute, says a senior Obama administration official.

"A majority of individuals would say, 'If I'm not going to get my insurance until Jan. 1, then I'm certainly not going to pay my premium on Oct. 1,'" says Dan Schuyler, a director at the consulting firm Leavitt Partners. "Realistically, a lot of people will not actually buy the product until the end of November at the earliest."

It seems to me restaurant owners are akin to the U.S. Department of Health & Human Services and the Obama administration, which have dedicated a significant amount of time lauding the reform law and its exchanges only to see almost no one going online to check out these new marketplaces.

The fact that President Barack Obama himself has been singing the praises of the exchanges and reform law during speeches all week leading up to the open enrollment period starting Tuesday doesn't mean anyone will actually start shopping right away. Even his pleas that his audiences share information about the exchanges to their friends won't gaurantee anyone will follow through.

"You can go to the website and check it out; you can see if what I'm saying is true. ... You can sign up," Obama told students at Prince George's Community College in Largo, Md. "Tell your friends, tell your classmates, tell your family members about their new healthcare choices." He added that shopping on the marketplaces will be like searching on Kayak.com for flights or on Amazon.com for TVs.

But the reality is, more likely, there's still a long uphill battle HHS and the White House will have to climb before they can successfully motivate the masses of people eligible to shop on exchanges.

"The law is entering a new phase where it becomes real," says Drew Altman, president of the Kaiser Family Foundation. "A lot is going to turn on how smooth the process is, whether people get coverage and whether they like the coverage they get."

Pins likely will be dropping all over the country in only a few days on these virtual insurance shops, and we're all going to be able to hear them crystal clearly--while consumers won't be making a peep.

But just like the restaurants that can barely seat a few tables at once each night, I remain hopeful federal officials can eventually muster up the interest to compel consumers onto these exchanges. May the restaurants and the online marketplaces flourish with activity soon. - Dina (@HealthPayer)

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