HHS convinces only 19 to go it alone with ACA exchanges
This article was originally published in Scrip
The midnight deadline came on 14 December, and only 18 states joined the District of Columbia in declaring they would set up their own health insurance exchange – the centerpiece of the Patient Protection and Affordable Care Act (ACA).
Only a few additional states chose to opt in to the idea of building and running their own exchanges by the cutoff than the 15 Health and Human Services (HHS) officials had reported a day earlier during a House hearing, with unsurprisingly most of the Republican-run states standing back and letting the federal government take over the process – something the Obama administration had hoped to avoid, but nonetheless, had been expecting as the deadline drew near (scripintelligence, 14 December 2012).
The enrollment for the exchanges is expected to begin by 1 October 2013 for the January 2014 launch under the ACA statutory requirements – a deadline Gary Cohen, director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare & Medicaid Services (CMS), insisted exchanges, whether they are state or federally run, will be prepared and ready to meet.
Avalere Health, a Washington-based health care business and policy research and analysis firm, said that because the majority of exchange enrollees will access coverage through systems that are operated by the federal government, "key federal decisions about plan participation, the consumer interface and outreach activities, eligibility and enrollment and options for small businesses will have a crucial impact on individuals' experiences with the exchanges."
Avalere, which correctly predicted a day before the deadline which states would choose to build and run an exchange, noted that guidance on how the federal exchanges will operate many of those functions is still outstanding.
The exchanges are meant to be online marketplaces where Americans can choose from numerous private health insurance plans, giving those consumers s options for what best fits with their budgets.
By increasing competition between insurance companies and allowing individuals and small businesses to band together to purchase insurance, Obama administration officials have contended that the exchanges will help lower Americans’ costs.
"The marketplace will provide consumers and small businesses one-stop shopping for health insurance with better information about plan benefits, quality and cost – simplifying the process for buying health insurance," HHS Secretary Kathleen Sebelius said in a 17 December blog posting, confirming only 19 total were on board, for the time being, with the state-run plans.
The exchanges are important to drug makers because they mean potentially millions of new customers whose prescriptions for medicines might otherwise go unfilled due to lack of insurance coverage (scripintelligence, 21 November 2012).
But for the states that did not declare they would run their own exchanges, they have another option: partnering with the federal government, with the deadline for that opportunity not hitting until 15 February, under an extension Secretary Sebelius granted last month (scripintelligence, 12 November 2012).
States that have opted to not operate the exchanges for the first year also can still apply at any time to run the marketplaces in future years, HHS emphasized.
The agency currently is reviewing the state exchange blueprint applications on how the states plan to run the exchanges from California, Hawaii, Idaho, Minnesota, Mississippi, Nevada, New Mexico, Rhode Island, Vermont and Utah.
HHS has until 1 January to "conditionally" approve the blueprints for those states. The agency already has conditionally approved blueprints for Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington.
In addition, the District of Columbia, Kentucky and New York, whose applications also have been conditionally approved, are well on their way of setting up their exchanges, Secretary Sebelius pointed out.
Utah Republican Governor Gary Herbert has asked the HHS chief if she would approve his state's plan to broaden its current online marketplace insurance tool for small businesses, known as Avenue H, as qualifying, once tweaked, for a state-based exchange for all of its state’s consumers – insisting that it "meets the broad goals and objectives of the ACA."
Governor Herbert told Secretary Sebelius in a 14 December letter that he intended to move forward with his version of an exchange and wanted her to certify it.
"In fact, Utah's version should serve as the minimum standard for all federally compliant health exchanges," he said.
The Utah governor said he would prefer a state-based approach if he were to have the flexibility to stay "true to Utah principles."
"It is becoming increasingly clear that there are many potentially detrimental federal exchange features," Governor Herbert said.
But CMS' Mr Cohen said last week that his agency plans to consult with a variety of experts and stakeholders on setting up the federally run exchanges.