Ex­change lead­ers gather to strate­gize sur­vival

Modern Healthcare - - THE WEEK AHEAD - —Bob Her­man

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.

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