Federal Government To Run Insurance Marketplaces In Half The States
By Phil Galewitz and Alvin Tran
KHN Staff Writers
Feb 15, 2013 - Kaiser Health News
Updated at 12:09 p.m. Feb. 19 to reflect that West Virginia is
seeking a partnership exchange with the federal government, while South
Dakota is not.
It's official. The Obama administration will be running new health insurance marketplaces in at least 26 states—
including the major population centers of Texas, Florida and Pennsylvania.
The federal government had hoped more states this week would agree to form a
partnership exchange—the deadline to apply was Friday—but the offer was largely
rebuffed. New Jersey, Ohio and Florida, several of the biggest states that had
not declared their intentions, officially said no late in the week.
"I have determined that federal operation of the Exchange is the responsible
choice for our state," New Jersey Gov. Chris Christie, a Republican, wrote in
letter Friday to Kathleen Sebelius, secretary of the Department of Health and
Human Services.
For consumers, it should make little difference whether the new Internet
sites are run from state capitals or Washington, D.C. But federal regulators
hoped states would shoulder some of the work and stakeholder groups such as
hospitals and insurers wanted states to help as well. The exchanges will open
for business Oct. 1.
The Obama administration has given "conditional approval" to 17 states and
the District of Columbia to run their own marketplaces, which will offer
one-stop shopping for private insurance or Medicaid, the state-federal health
insurance program for the poor. About 12 million people are expected to buy
coverage through the Internet sites next year, with the number increasing to 29
million by 2021, according to consulting firm PriceWaterHouseCoopers.
Twenty-six
states, most Republican-led, have indicated they will let the federal
government run the marketplaces, also known as exchanges. And
seven governors from Arkansas, Delaware, Illinois, Iowa, Michigan, New
Hampshire and West Virginia have sought approval for the third option— a
partnership with the federal government. Three of those -- Arkansas,
Delaware and Illinois -- have already received conditional approval.
In a partnership, states would approve which plans can participate on the
marketplace and handle consumer assistance duties such as setting up call
centers to handle inquiries. The federal government would handle the more
complex duties of running the website, marketing the site and
determining the eligibility of millions of people for government
subsidies which will make prices more affordable.
Health and Human Services Secretary Kathleen Sebelius said this week no
matter what governors decide, residents in every state will have a
marketplace on Oct. 1, which will sell coverage to individuals and small
employers. Those policies will take effect in January.
Consumers will generally see little difference in how the websites work
regardless of who operates them, say experts. Unlike buying insurance online
today, the marketplaces will offer standardized policies so consumers can easily
compare plans, something administration officials say should lead to more
competitive pricing.
Obama administration officials have said they prefer states to run the
marketplaces because they know their local communities and have longstanding
relationships with key groups, such as insurers and insurance agents.
Most hospitals, doctors, insurers and other stakeholder groups favored state
involvement where they thought they might have more sway. But most
states opted against operating an exchange, citing worries about cost and lack
of real autonomy or political opposition to the health law.
Nearly all states plan to finance their marketplaces with a tax or surcharge
on premiums that insurers will pass on to policyholders.
Its unclear if every state that has applied to run a state exchange will
get a green light. The administration rejected Mississippi's bid last week
after the governor said he would block the marketplace from connecting people to
Medicaid.
Idaho has yet to start building its exchange as it waits for
state lawmakers to pass legislation allowing it. Idaho is also the
only state to win conditional approval without having yet hired an
information technology vendor to start building its website. "It will require a
significant and accelerated effort to meet all of the necessary deadlines before
October open enrollment," said Carolyn Pearson, a director with consulting firm
Avalere Health.
Utah also has expressed doubts about going ahead with its own exchange
even though it has operated one just for small businesses since 2009.
And while Virginia and Ohio did not apply for partnership status, state
leaders have indicated they want to review qualified health plans.
Here is a breakdown of state actions.
States that have applied to run their own online marketplaces:
California, Colorado, Connecticut, District of Columbia, Hawaii, Idaho,
Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New
York, Oregon, Rhode Island, Utah, Vermont and Washington.
States that have applied to partner with the federal
government:
Arkansas, Delaware, Illinois, Iowa, Michigan, New Hampshire and West
Virginia.
States defaulting to the federal exchange:
Alabama, Alaska, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana,
Maine, Mississippi, Missouri, Montana, Nebraska, New Jersey, North Carolina,
North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota,
Tennessee, Texas, Virginia, Wisconsin and Wyoming.
© 2013 Henry J. Kaiser Family Foundation. All rights reserved.