Exchange leaders gather to strategize survival

Leaders of the federal and state insurance exchanges, policy experts and insurance executives are gathering in Washington this week to hash out the critical legal, technological, financial and policy issues facing the public health plan marketplaces.

The Affordable Care Act required state-run exchanges to be financially selfsustaining starting this year. But many of the exchanges in the 16 states and the District of Columbia are struggling to achieve that and are still using federal funds to keep their operations afloat. State lawmakers are debating how— or whether—to keep their exchanges going.

The third national Health Insurance Exchange Summit—featuring HealthCare.gov CEO Kevin Counihan and individual state exchange directors— will cover everything from website technological headaches to the implications of the looming U.S. Supreme Court decision that could deep-six premium subsidies and throw insurance markets into chaos.

On Tuesday, the executive directors of the exchanges in California, Idaho and Maryland will debate whether states should outsource the operations of their marketplaces.

The CMS has doled out $4 billion in grants to state exchanges, but many are still running deficits. Technology has been more costly than expected, and premium fees haven’t covered operating costs. Lawmakers are debating whether to raise or broaden insurance fees.

“Many state-based exchanges have a good amount of work to do before they find a sustainable financial model,” Elizabeth Carpenter, a director at the consulting firm Avalere Health, previously told Modern Healthcare.