The final decision on exchanges was made on Friday, with the nation split down the middle on whether states chose to facilitate their own or have it run by the government.
Texas led the way in declaring the federal government was to administer their new insurance marketplaces in advance, and come the deadline, many other states followed. Florida was still on the fence until yesterday, when they ultimately chose not to run their own program.
Pennsylvania was another major state to turn the responsibility over to the Obama Administration, making some of the most densely populated regions of the country now officially uninterested in participation. A partnership was also an option, agreeing to allow the feds to run the exchange while state officials help open the door to more resources. Most states declined the proposition, keeping as hands-off as possible.
Though who runs a state’s exchange may not make a difference to consumers, it will shift most of the effort of the operation onto federal officials. They were optimistic that states would be willing to share some responsibilities, and get state hospitals, clinics, and health plans involved. This cooperation would make more facilities available, and require less work from government. Unfortunately for the feds, they now have 25 different marketplaces to organize, set up, and open by October 1.
The states who opted out were mostly under Republican leadership, not surprisingly, and eight states chose the partnership. A federal-run health insurance marketplace will operate with state-level involvement in Arkansas, West Virginia, Delaware, New Hampshire, Illinois, South Dakota, Iowa, and Michigan. Through the partnership option, states have a voice in deciding which plans can be used, as well as organizing and staffing call centers to help people understand the exchanges and their products.
This leaves the federal government with less work in these states than others, but theirs is the more technical and detailed. They are responsible for managing and marketing the website, and for weighing who is eligible for tax credits to reduce their premiums. Determining whether each applicant (of millions) qualifies for a subsidy will be considerably time consuming.
Federal officials have mentioned that they would rather have states run their own exchanges, as they have a better knowledge base for local resources, and already have established relationships with insurers, agents, and facilities that could help the new marketplace get moving faster.
And while they claim to want the help, there are still numerous states whose state-run marketplaces have yet to be approved. Last week, the administration vetoed Mississippi’s proposal, which the governor stated would prevent people from accessing Medicaid through their exchange. Bad call, Mississippi.
In Utah, the state has run its own health insurance marketplace for small businesses since 2009, but still has yet to make any progress on their exchange. Idaho is also putting off any efforts to start their exchange until the state legislators pass a law to permit them to do so. Somehow, Idaho received “conditional approval” from the Obama administration without even an information technology provider in place to work on the site.
All states and the federal government will be rushing to complete their exchange sites, pass laws on essential benefits, hire the help, and create a working marketplace in a few short months. “It will require a significant and accelerated effort to meet all of the necessary deadlines before October open enrollment,” said Carolyn Pearson, director of Avalere Health, D.C.-based advisory firm.
Check the map above to see if your state is running its own exchange, forming a partnership, or letting the feds run the show.
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