State Officials in Stealth Mode on Health Insurance Exchange Planning

Reuters reports on under-the-radar efforts by state insurance commissioners to set up health insurance exchanges, even in states that are technically opposed to the health law.

The healthcare reform law passed in 2010 calls for health insurance exchanges to be in full operation by January 2014, helping to extend care to up to 16 million uninsured Americans.

So far, only 13 mostly Democratic states have formally committed to establishing their own insurance exchanges, while a handful of others have said they would probably do it or agreed to form a partnership with the federal government. Seven states have outright refused.

In the remaining 24 states with Republican governors or Republican majorities in either legislative house, heated opposition means work on exchanges occurs haphazardly, behind the scenes and with fewer funds.

Half a dozen Republican state health officials interviewed by Reuters said they prefer to plan for exchanges now, rather than accept blame down the road for a federally-run exchange that leaves voters worse off than their neighbors.  At least 15 others are also preparing for some kind of exchange, according to state planning documents, news articles and the Kaiser Family Foundation, which tracks states' actions.

Even without political obstacles, setting up health exchanges is not easy: many states need new laws to create and fund an exchange; they have to study local needs through dozens of meetings, hire staff and find contractors to set up the technology. Many governors have publicly stated that they will wait to see the outcome of the election on November 6 of this year. But states must report to HHS by November 16 if they are planning to run their own exchanges, and 10 days is certainly not enough time to overcome these obstacles and put a plan in place.

Joel Ario, who until last year ran the federal government's office of insurance exchanges, said he was once asked how many states had refused to discuss the program as their leaders battled the ACA.
"The answer was zero," said Ario, now managing director at Manatt Health Solutions. "Every state insurance department is engaged. (Though) if you called all of them, some of them might deny it."

As mentioned during the NBCH member webinar series on exchange implementation, if exchange implementation is of interest to your members, coalitions are encouraged to do a little bit of digging into what the situation in their states might be, and to figure out if there are ways to be involved.