The emerging state insurance exchanges suggest that states’ rights are alive and well.
As the implementation of portions of the Patient Protection and Affordable Care Act approaches, state exchanges are beginning to take form and substance. The Commonwealth Fund surveyed all 50 states and the District of Columbia to see how things were going, and found plenty of diversity among the characteristics of the various exchanges.
One message that came through loud and clear: About a third of the states are moving much faster than the feds to provide coverage to individuals and small-business workers through their exchanges.
The Commonwealth Fund focused on the 17 states and the District of Columbia that have decided to establish state-based exchanges rather than go through the federal program to offer coverage.
There was plenty of meat in the report for insurers, as well as anyone in the business of selling or buying employee benefit plans. Some highlights:
1. States are deciding how to fund their exchanges, and some will assess insurers to do so. The report says:
Seven states and the District of Columbia remain undecided on their long-term revenue source; most of the remaining states will assess insurers that offer coverage in the exchanges. State officials reported that decisions in these areas often reflected compressed timelines, political realities, and the state’s long-term vision for the exchange.
2. In some states, if insurers don’t participate this year, they’ll be barred from future participation. The report says:
Ten states and the District of Columbia adopted formal requirements regarding exchange participation or alignment of coverage options inside and outside the exchange. These mechanisms include establishing a single marketplace, prohibiting insurers from entering the exchange if the insurer did not participate in 2014, and requiring insurers to offer the same coverage inside and outside the exchange.
3. Insurers are going to have to be flexible, and get used to increased government oversight, when it comes to meeting the needs of small business employees. The report says: