Alabama has taken its $1 million in federal health insurance exchange funding and is holding meetings. Wisconsin has received about $39 million and is about to recruit technology vendors.
Other states are at different stages of health insurance exchange development.
Analysts at the Henry J. Kaiser Family Foundation, Menlo Park, Calif., have described the stage of exchange development in each state in a new collection of state exchange program profiles.
The Patient Protection and Affordable Care Act of 2010 (PPACA) calls for each state to have an exchange, or collection of one or more exchanges, that will give individuals and small groups easy access to high-quality health plans that meet federal quality standards.
Individuals are supposed to get new federal income tax subsidies that they can use to buy coverage through the exchanges starting in 2014.
Massachusetts already has an exchange that offers a limited number of plans, and Utah has an exchange that is open to any qualified plan that wants to participate.
The U.S. Department of Health and Human Services (HHS) has said it will be as flexible about exchanges as the law allows.
A state can operate its own exchange, join a multi-state consortium or let the federal government offer exchange services to its residents.
A state can put a government agency in charge of the exchange program or turn it over to an independent group.
A state also can decide how open it wants to be to insurers and brokers.
A few states have taken aggressive steps to say they will not have anything to do with the exchange program, but most states have taken $1 million federal exchange planning grants. States can use the $1 million grants to look into the idea of participating in the exchange program, even if they decide against doing so.
In Alabama, for example, Gov. Robert Bentley, R, has issued an executive order creating an Alabama Health Insurance Exchange Study Commission to recommend how Alabama should establish a health insurance exchange, the Kaiser analysts said.
An exchange establishment bill failed.
The study commission is supposed to submit recommendations about the exchange program to the governor and lawmakers by Dec. 1.
In Wisconsin, the state Department of Health Services received a $1 planning grant in September 2010 and a federal “Early Innovator” grant for about $38 million in February.
There, Gov. Scott Walker, R, has issued an executive order creating the Office of Free Market Health Care which is supposed to “conditionally develop a plan for the design and implementation of a Wisconsin health benefit exchange that utilizes a free-market, consumer driven approach.”
Wisconsin has indicated that it will establish its own exchange, and it is using the Early Innovator grnat to build an exchange prototype with help from the vendors that will be hired, the Kaiser analysts said.
The analysts noted that Wisconsin also plans to use subcontractors to help with exchange marketing.