Some state-based exchanges want to team up to take on the HealthCare.gov health insurance exchange administration gorilla.
Bruce Gilbert, the executive director of the Silver State Health Insurance Exchange, the agency that oversees Nevada’s Nevada Health Link exchange, says his state and others want to hear more about the multi-state exchange technology platform the Oregon exchange board is trying to set up.
The Centers for Medicare & Medicaid Services (CMS), the government agency that runs HealthCare.gov, has proposed charging the insurers on state-based exchanges that use HealthCare.gov systems a user fee of at least 3 percent per enrollee.
In Nevada, Gilbert says, the legislature has set the exchange user fee at 3 percent. That means that, under current law, the proposed HealthCare.gov user fee would eat up all the money that Nevada now uses for exchange marketing and exchange plan oversight, Gilbert says.
The cost is especially high given that HealthCare.gov provides lousy information reporting services, Gilbert adds.
“State-based marketplaces on the federal system do not have access to real-time or ad hoc reporting,” Gilbert says. “Whatever the informational needs of a state, the data reported will be that chosen by the federally facilitated marketplace and released when as it chooses.”
Gilbert describes his concerns in a written version of remarks prepared for an exchange board meeting. The exchange staff also talks about the HealthCare.gov fee concerns in an exchange financing update document.
CMS, an arm of the U.S. Department of Health and Human Services (HHS), set up the HealthCare.gov enrollment and enrollee system to provide Patient Protection and Affordable Care Act (PPACA) exchange services in states that are unwilling or unable to run their own exchange programs.
Some of the states that use the HealthCare.gov system, including Nevada, Oregon and Hawaii, originally tried to set up their own exchange enrollment systems but switched to using HealthCare.gov systems because they ran into serious technical problems.
Nevada and Hawaii, for example, still have exchange program boards and exchange marketing programs. They see themselves as having state-based exchanges that happen to use HealthCare.gov information technology (IT) systems.
Some Republican critics of PPACA have complained about CMS failing to charge state-based exchanges for use of HealthCare.gov services.
CMS first proposed setting the HealthCare.gov user fee at 3.5 percent of premiums in draft regulations released in November 2012. In the states in which HealthCare.gov handles all exchange duties, the insurers that issue the plans sold through an exchange pay the user fee.
In late December, when CMS proposed setting the HealthCare.gov user for issuers in a state-based exchange that uses HealthCare.gov at 3 percent of revenue, the agency said it could collect an additional amount for a state that wanted to use a portion of the user fee to pay for its own exchange-related expenses.
CMS suggested that it could help states get used to the new fee system by charging them a user fee of just 1.5 percent or 2 percent of revenue for 2017.
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