At least they know what to call it.
This week, officials unveiled the new name for Washington's nascent Health Benefit Exchange -- Washington Healthplanfinder -- along with a blue and green logo and the tagline "click.compare.covered."
But judging by the conversation Tuesday at AWB's 2012 Health Care Forum, there is still a fair amount of confusion about what, exactly, the entity is.
Technically, it's a quasi-public organization, not quite a government agency but not exactly private.
The exchange receives government funding and its first employees came from the state Health Care Authority, moderator Jeff Gingold noted during a panel discussion with state legislators, members of the exchange board and small-business owners.
Others pointed out that the exchange receives legal counsel from the state Attorney General's Office and employees receive health and retirement benefits from state programs.
"It looks to me like a government agency," said Gingold, managing partner at Gingold Law Firm.
If it's unclear exactly what the exchange is, it was even less clear to panelists how it will receive funding and whether it will ever be self-sustaining.
Washington business owners have worried for a while now that their health care costs will increase once the exchange -- a key component of President Obama's health law -- begins operating next year, regardless of whether they actually use it buy health insurance for their employees.
The discussion Tuesday did little to calm those fears.
State Rep. Eileen Cody, D-West Seattle, said the exchange was never intended to address the problem of health care costs, but rather to solve the problem of providing health care coverage to everybody,
"I think that now, with the coverage issue solved, we'll move forward with the issue of cost," Cody said.
The problem of cost could be significant. The administrative costs alone for running the exchange are projected to be $50 million per year, a price tag that disturbed some panel members.
State Sen. Linda Evans Parlette, R-Wenatchee, noted that other states are setting up benefit exchanges that will cost considerably less than $50 million per year to run, and they will preserve an insurance market outside of the exchange, something that is in doubt in Washington.
Don Conant, general manager of Valley Nut and Bolt Company and member of the state exchange board, said he worries about the long-term viability of the exchange. It may seem like a good deal for consumers at first, when the federal government is providing generous subsidies.
But eventually, the subsidy is going to drop, said Conant, who compared it to an adjustable rate home mortgage.
"It's great until the payment re-sets, and then you're sunk," he said.
Knowing that costs will go up isn't the only concern, added Steve Neighbors, CEO of Terra Staffing. Not knowing with any degree of certainty how much insurance costs will rise under the new system makes it hard for businesses like his to plan ahead.
"How do we write a one-year contract when we don't know what the cost will be?" he asked.
Gary Chandler, AWB's vice president of government affairs, captured the concerns of many employers during his introduction of the panelists.
Health care reform, and the state exchange, is here to stay, Chandler said. The challenge is figuring out how to move forward and how best to answer questions about how to pay for it.
"I don't see any costs going down," Chandler said. "I see costs going up. And I'm not sure we are going to get anything more."