Health Insurance Exchange Deadline Looms Large

States must decide whether to set up their own health insurance exchange or participate in a federal program by November 16.

Update (November 12): This deadline has been extended. Read more here.

Following the Supreme Court’s decision last summer to uphold the Affordable Care Act (ACA) and, in particular, the mandate that requires most Americans to purchase health insurance, many states are scrambling to make policy decisions and meet fast-approaching deadlines set in the law.

Up next: States must let the federal government know whether they plan to operate a state-run insurance exchange or a state-federal partnership exchange.

While the creation of state-based health insurance exchanges is a key component of the law, only 15 states and the District of Columbia have begun establishing one. Exchanges, which will be the marketplace for millions of individuals and small businesses to shop for health coverage, are required to be operational in every state by January 1, 2014.

In my opinion, the biggest (and most ubiquitous) problems for states are the simultaneous overabundance of information and the general lack of information from HHS.

States that don’t build their own exchange default into a federally run exchange. It’s been projected that many states that want to operate their own exchange may not be able to get them up and running by 2014 and that the federal government may have to create exchanges for 30 or more states in the first year of operation.

While many states waited until the last minute to hear the outcome of the Supreme Court case, state officials also say they’ve received little guidance from the federal government on how the exchanges should work. The Department of Health and Human Services (HHS) outlined 10 essential health benefits that are the minimum standards states must meet, including basic needs like ambulatory services, emergency services, hospitalization, and prescription drugs.

As states weigh whether to create their own exchanges, they have little idea about what a federally run exchange would look like by comparison.

“In my opinion, the biggest (and most ubiquitous) problems for states are the simultaneous overabundance of information and the general lack of information from HHS,” said Cheryl Smith, a director of Leavitt Partners, which advises states setting up exchanges, in an interview with USA Today last week. “At the very moment they are drinking from HHS’ fire hose of rules, regulations, and deadlines, states still don’t know what the federal exchange will look like, nor do they know [how much] a federally established exchange will cost them.”

Government officials say the law recognizes that each state has different demographics and affords state officials leeway to build their exchange based on which benefits meet their residents’ needs.

“Over the past two years, [HHS] has been in constant contact with the states, answering questions and providing guidance through bulletins, phone calls, webinars, in-person meetings, and rulemaking,” HHS spokesperson Erin Shields Britt told USA Today. “Many states have taken advantage of this guidance and have already made extraordinary progress toward establishing an exchange.”

The ACA identifies associations as a potential resource for states setting up insurance exchanges—especially playing the role of “navigator” in educating the public. Under the law, trade, industry, and professional associations are eligible for grants to help raise awareness about the exchanges.

“The trend in Washington is to have better partnerships with associations,” Justin Moore, PT, DPT, vice president for government affairs at the American Physical Therapy Association, told Associations Now.


(Photo by kuzma / 123RF)

Chris Vest, CAE

By Chris Vest, CAE

Chris Vest, CAE is vice president, corporate communications and public relations at ASAE. MORE

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