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As deadlines loom, many states competing against politics, regulations to set up insurance exchanges
Complexities of setting up exchanges threaten states' ability to meet 2014 deadline
Reforming the nation’s healthcare system may be, as the well-worn saying goes, a marathon and not a sprint. But when it comes to setting up the health insurance exchanges, as mandated by January 2014, states had better pick up the pace, experts say.
The deadlines are so compressed that many fear states, health plans and providers will be caught flat-footed in just a few years’ time when 30 million more people are expected to gain access to health insurance, largely through the exchanges. Politics are playing a leading role with governors, statehouses and sometimes state insurance commissioners at odds about how and whether to proceed with the federal mandate.
And the success or failure of the exchanges will likely depend on work done in the next 18 months.
“Time is not our friend,” said Dr. Bruce Goldberg, director of the Oregon Health Authority, which is tasked with setting up that state’s exchange. “2013 is upon us.”
To date, the federal government has spent about $325 million to help states prepare to create these new online marketplaces, where individuals and small businesses—and later, workers at large firms—can purchase health insurance. Many more millions of dollars will be spent toward the effort.
“Federal regulators have been pretty relentless in reaching out to the states,” said Candy Gallagher, vice president of state policy at America’s Health Insurance Plans, at the group’s annual conference in San Francisco in mid-June. “They are really doing an incredible amount of outreach. They are committed to this.”
As soon as this week, HHS is expected to release long-awaited proposed rules on the health insurance exchanges, which will provide guidance to states on how much flexibility they will have in crafting them, including eligibility, enrollment and other issues.
In the meantime, legislation to start the process of setting up exchanges has been introduced in 34 states, with about a halfdozen states enacting legislation. But more than half of all states have either seen bills
Colorado’s Hickenlooper is taking a business-friendly approach to HIEs by appointing insurance executives to its nine-member board.