ACA health insurance exchange tally shows heavy reliance on federal help

The deadline passes to commit to federal-state partnership exchanges, although some states that missed it still hope to retain some regulatory control.

By — Posted Feb. 25, 2013

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As Illinois moves forward with plans to partner with the federal government on running a health insurance exchange starting next year, physicians in the state remain hopeful that eventually they’ll have some say in how the exchange is governed.

Realistically, the state needed to partner with the federal government to get such a coverage marketplace off the ground by Oct. 1, when residents would start enrolling in the exchange, said William Werner, MD, president of the Illinois State Medical Society. Physicians in the state aren’t too concerned about whether this is a federal or state-run product, he said. “We want to be sure that there’s transparency for our patients when they go online that will allow them to do the best purchasing decision for their needs.”

Illinois is one of the latest states to achieve clarity in the path it will take on the health insurance exchanges, which were created by the Affordable Care Act to provide consumers with new marketplaces through which to shop for affordable plans.

At this article’s deadline, 16 states and the District of Columbia planned to run their own exchanges, and an additional seven states were pursuing exchanges run as a partnership with the federal government, according to the latest figures from Washington consultant Avalere Health LLC. States interested in pursuing partnership exchanges — in which they get to retain insurance plan management and consumer education roles while taking advantage of the federal government’s financial and structural support — had until Feb. 15 to declare their intentions.

The deadline was significant in that it marked the direction in which all states essentially are headed with their exchange marketplaces. States that don’t receive approval either to run their own exchanges or participate in partnership exchanges will default to the federal government to run their marketplaces for them.

At this article’s deadline, that meant more than half of the states would have a federal exchange, although several states still were proposing to retain some measure of regulatory control over the marketplaces. Ohio and Virginia had not submitted partnership exchange proposals but intended to manage health plans on those marketplaces, while Utah was requesting that the government certify an existing state insurance exchange that applies only to small-business plans, according to Avalere.

Illinois doctors still want input

Illinois joined Arkansas and Delaware in obtaining conditional approval from the Dept. of Health and Human Services to help run partnership exchanges, following the state’s struggles to get a bill through its Legislature to create a state-run exchange.

“Access to decent health care is a fundamental right,” Illinois Gov. Pat Quinn said in a statement. “Hundreds of thousands of people in Illinois will gain quality health coverage through the Health Insurance Marketplace. They will also gain the peace of mind that comes from knowing that the care will be there if they need it.”

The state estimates that the exchange will cover at least 500,000 people in its first year and up to 1 million by 2016.

Illinois is pursuing a partnership for now, but the expectation is that the state eventually will approve legislation to run its own exchange, Dr. Werner said. Doctors want to make sure they have a role in the governance structure of the marketplace when such a transition in control takes effect.

“Hopefully, physicians will have a hand in shaping what this legislation’s going to look like in a state-based marketplace. We’re going to watch this very carefully,” Dr. Werner said. Ensuring that all physicians have access to the insurance networks offered to consumers through the exchange is another priority for doctors, he said.

Illinois probably tops the list of states most likely to convert to a state-based exchange, either for the 2015 or 2016 benefit years, said Caroline Pearson, a vice president with Avalere Health. “They had done a lot of planning and put a lot of energy into how they wanted to run their own exchange, but they simply couldn’t get legislative authority through with the time they needed. But I would expect they’d have the will to consider that in the future.”

It won’t be the only state doing this, either, she said. During the next few years, other states may consider transitioning from a partnership to a state-based model when all of the health information technology and vendors associated with the exchanges have been put into place. “The administrative and financial efforts associated with converting models should be more manageable,” Pearson added.

For consumers, it’s not going to make much of a difference what the exchange model is, she said. Each exchange will have plans coming to the market, and there will be a website and federal subsidies for those who need financial assistance. Whether payment rates for physicians and other health care professionals will be better or worse under a certain exchange model is “not really clear at the moment,” Pearson said.

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The federal-state marketplace pool

Seven states have committed to pursuing state-federal partnership health insurance exchanges at this article’s deadline, according to an analysis by Washington consultant Avalere Health LLC. That means fewer than 750,000 people so far are expected to sign up for coverage in the first year through a marketplace that will be run by the federal government but with the state retaining some measure of regulatory control.

Partnership state 2014 projected enrollment*
Arkansas 69,000
Delaware 18,000
Illinois 278,000
Iowa 68,000
Michigan 218,000
New Hampshire 31,000
West Virginia 40,000
Total 722,000

*Enrollment numbers reflect current state positions on Medicaid expansion. Iowa officials have indicated that they will not expand Medicaid starting in 2014, which increases the state’s anticipated enrollment through the exchange.

Source: Avalere Health LLC, updated Feb. 19

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External links

“16 States and DC Likely to Run Exchanges in 2014, 7 states Committed to Partnership Model,” Avalere Health LLC, Feb. 19 (link)

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