5 platinum-budget PPACA exchange programs

Building public exchange programs costs a lot more in some states than in others.

Managers of Hawaii’s state-based Hawai’i Health Connector Patient Protection and Affordable Care Act (PPACA) exchange have helped PPACA watchers understand the costs by putting spending comparison tables in their 2014 annual report.

The managers provide data on estimated costs, through the end of fiscal year 2014, at all 14 of the surviving state-based, state-administered PPACA exchanges that sell individual qualified health plan (QHP) coverage.

The managers had to contact people directly to get cost information for some exchanges, and they say they are not sure whether they are stating all of the costs on an apples-to-apples basis. In Idaho, for example, the exchange has just started selling QHP coverage, and that might affect the spending total given in the Hawaii table, officials say.

But the exchange staff members who created the table found that total spending at the surviving state-based exchanges seems to have ranged from about $46 million in Rhode Island to $702 million in California.

The average estimated cost per resident ranged from about $15 in New York state up to about $210 in the District of Columbia.

The average estimated cost per uninsured resident ranged from $108 in California to $3,158 in the District of Columbia.

The Hawaii exchange managers created the tables to support discussions about PPACA provisions that require PPACA exchanges to use state money, grants and their own revenue to pay their operating expenses after the first year of operation.

Officials have noted that expenses for some exchange construction functions, such as paying for basic legal expenses, may cost about as much for small exchanges as for big exchanges. Advocates for running locally based exchanges in those jurisdictions have argued that keeping an exchange in local hands can make it more flexible, and more familiar with local residents’ needs.

Jeffrey Kissel, the executive director of the Hawai’i exchange, has argued that PPACA watchers should consider the value an exchange can provide by helping more people get covered as well as an exchange program’s construction and operating costs when analyzing a program’s finances.

For a look at what the Hawai’i exchange managers learned about actual expenses when they tried to benchmark themselves, read on.