Health Insurance Exchanges under the PPACA

[MichaelB]

Just speculating, but a few reasons a State might choose to run the exchange:

- they can ensure compliance with their existing insurance regulations

- they can include other public health care programs, such as Medicaid and children's health insurance programs

- State's rights

- they want to influence which insurance companies and products are offered in the exchange

The cost to set up and operate the exchange

 

[MichaelB]

The deadline has passed for State Governors to inform HHS of their intention to set up and run the health exchange. Here is the latest status, updating the first post to highlight the changes.

[-]16[/-] 19 To Establish State Exchange: California, Colorado, Connecticut, DC, Hawaii, Kentucky, Maryland, Massachusetts, Nevada, New York, Oregon, Rhode Island, Utah, Vermont, Washington, [-]West Virginia[/-] Idaho, New Mexico, Minnesota, Mississippi,

[-]3[/-] 7 Planning for Partnership Exchange: Arkansas, Delaware, Illinois. Iowa, Michigan, North Carolina, West Virginia,

[-]16 Studying Options[/-]: [-]Alabama[/-], A[-]rizona[/-], [-]Idaho[/-], I[-]ndiana[/-], [-]Iowa[/-], [-]Michigan[/-], [-]Minnesota[/-], [-]Mississippi[/-], [-]Montana[/-], [-]Nebraska[/-], [-]New Jersey[/-], [-]New Mexico[/-], [-]North Carolina[/-], [-]Pennsylvania, Tennessee, Virginia[/-]

[-]8 No Significant Activity[/-]: [-]Georgia, Kansas[/-], [-]Missouri[/-], [-]North Dakota[/-], [-]Ohio[/-], [-]Oklahoma[/-], [-]Wisconsin, Wyoming[/-]

[-]8[/-] 25 Decision Not to Create State Exchange: Alabama, Alaska, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Virginia, Wisconsin, Wyoming

Utah has a special request which may be denied, so it is not final.

From this point, what can change? A state may want to set up its own exchange but be unable to do so and find itself moving into the partnership or federal exchange group. HHS can also reject a state application. If either of these happen we should know relatively soon.

A state may allow HHS to set up the exchange and then ask to take it over and run it. This is a real possibility, but the logistics of a new operation make this unlikely for the first year or so, which means this becomes more likely in 2016 and beyond.

Another possibility is a state changing it's mind and choosing to set up its own exchange. The effort, investment and lead time needed for this is such that the real likelihood is small and declining at a very fast pace.

 

[audreyh1]

Thanks, Michael, for keeping us updated on this.

 

[rbmrtn]

I came across this web page that is a easy to read point by point explanation of PPACA changes and links to supporting information in the actual document. Thought it was very well laid out and easier to digest.

Political Irony › ObamaCare Explained So Everyone Can Understand It

 

[marko]

I came across this web page that is a easy to read point by point explanation of PPACA changes and links to supporting information in the actual document. Thought it was very well laid out and easier to digest.

Political Irony › ObamaCare Explained So Everyone Can Understand It

Excellent synopsis! Thanks!

Although, with all the other good detail in this article, I find the short reference to "Cut some Medicare" a little unnerving.

 

[ERhoosier]

I came across this web page that is a easy to read point by point explanation of PPACA changes and links to supporting information in the actual document. Thought it was very well laid out and easier to digest.

Political Irony › ObamaCare Explained So Everyone Can Understand It

Easy to read, but now somewhat outdated & incorrect in some cases. For example-
1. IMPB (Independent Medicare (not "Medical" as author cites) Advisory Payment Board) does indeed have real power. Unlike author's claim, under Sec 3403b Congress must pass legislation to STOP (not implement but STOP) IMPB spending limit proposals. Sec 3403b3 states Sec of HHS is required to implement IMPB's proposals "...UNLESS (emphasis added) Congress enacts legislation pursuant to this section."
2. In practice you are NOT able to always keep your current HI Plan if you wish. Current Plans are already being involuntarily changed due to ACA (e.g. Many Medicare Advantage plans, private Plans not covering birth control, etc.).
Medicare Advantage plans expected to increase by 7 percent in 2013 | Healthcare Finance News
Hobby Lobby files appeal in battle against ObamaCare contraception provisions | Fox News
3. In view of many ([mod edit]) ACA is indeed requiring coverage for certain abortions (e.g. drug-induced AB's with not only morning-after pills but weeks-after pills).

I could go on, but bottom line is NO ONE knows how this will all turn out. Sec of HHS has great power to alter implementation features (e.g. through delaying deadlines, waivers, etc.), Courts will still weigh in on various details, and future legislation will shape things too.