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5 platinum-budget PPACA exchange programs

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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.

See also: 5 ways cash-hungry PPACA exchanges could take you on

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.

Hartford's Old State House

5. Connecticut: $44.13 per resident

Total cost: $156 million

Uninsured population: 333,000 

Cost per uninsured life: $470

See also: 7 facts about the users of the ‘good PPACA exchange’

Image: Hartford’s Old State House (AP photo/Bob Childs)

Newport, R.I., waterfront

4. Rhode Island: $44.40 per resident

Total cost: $46 million

Uninsured population: 120,000

Cost per uninsured life:  $382

See also: Rhode Island tinkers with 2015 health rates

Image: Puck sketch/Raymond C. Ewer 

Hula dancer

3. Hawaii: $77.71 per resident

Total cost: $105 million

Uninsured population: 91,000

Cost per uninsured life: $1,152

See also: New Hawaii exchange chief chosen.

Image: AP Photo/Ronen Zilberman 

Vermont wetlands

2. Vermont: $115.96 per resident

Total cost: $72 million

Uninsured population: 45,000

Cost per uninsured life: $1,603

See also: Vermont governor’s nightmare is almost over

Image: Vermont’s Missisquoi National Wildlife Refuge. (U.S. Fish and Wildlife Service/Ken Sturm)


1. District of Columbia: $210.08 per resident

Total cost:  $134 million

Uninsured population: 42,000

Cost per uninsured life: $3,158.15

See also: DC considers how to fund exchange

Image: LHP photo/Allison Bell


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