State health care exchange plans still must be in place for approval by Jan. 1, 2013, but the U.S. Department of Health and Human Services will help support the process operationally as states move toward exchange certification, according to Amanda Cowley, acting director for state health exchanges, for HHS's Centers for Medicare and Medicaid Services.
"States have made some progress," Cowley told participants at America's Health Care Plans state issues conference in Washington Thursday. "States are a lot smarter now than they were a year ago. Over 80% of states have done background research," she said. HHS is beginning to see states act but the extent varies widely, she said. But HHS is "seeing a movement and very pleased with that."
With that, HHS is trying to "intensify" its response to the states, and has been holding listening sessions and "imagining a highly collaborative" process.
Recommended For You
The proposed HHS rule allows for conditional approval of a state exchange if the State is advanced in its preparation but cannot demonstrate complete readiness by the January 2013 deadline. The proposed rule also allows States that are not ready for 2014 to apply to operate the Exchange for 2015 or any subsequent year. HHS will continue working with States to support their progress.
According to a source, HHS supposedly hiring another 150 people just to work on exchanges.
If a state does none of these things or rejects the creation of a state health care exchange, those that would be insured default to a federal exchange in the PPACA.
So far, two states, Massachusetts and Utah, have –and have had–exchanges up and running. According to a recent chart, nine states have enacted state exchanges, 12 states have failed legislation, six states have legislation pending, 17 states have either an executive order or study underway, and 8 states have no bill or anything else. Republican states that are rejecting the exchanges are often termed "red states."
Some insurance companies are wondering how, if a federal exchange takes over, as might happen with the short legislative sessions in 2012 being the last chance for some states to pass a bill, how a federal exchange would handle things like Medicare eligibility.
Many health plans, like Blue Cross Blue Shield think the exchanges are preferable to a federal one. They will be adding new members, and while the details may be uncertain, they are embracing the potential—given the alternative.
Some are worried about such tangential business issues that there will be a brain drain—that health care plans' good IT people might leave and join the federal exchanges.
"From what I have seen, states overwhelmingly want state exchanges," said the National Governors Association's health policy director, Krista Drobac at the AHIP conference. She said states need more guidance on key issues to help them make their case to state legislators. They also do not want to be responsible for doing program integrity around the exchanges to begin with, she said.
HHS has extended the comment period for exchange rules pertaining to risk adjustment and other issues, such as infrastructure questions, and huge IT challenges.
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
