As dead­lines loom, many states com­pet­ing against pol­i­tics, reg­u­la­tions to set up in­surance ex­changes

Modern Healthcare - - Front Page -

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.

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