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Setting up exchanges may be tough for latecomers, experts say


By Rich Daly
Posted: November 14, 2012 - 1:45 pm ET
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States that have waited until after the Nov. 6 federal election to decide to pursue an insurance exchange face an “enormous lift” that could limit the number that will operate such a marketplace, according to exchange experts.

A leader of the Maryland exchange, which state officials have spent two years designing and building, questioned the ability of states to begin planning now and start enrolling beneficiaries by October 2013.

“It is going to be an enormous lift at this point to be able to try to make this happen if you haven't engaged up until now,” said Tequila Terry, director of plan and partner management for the Maryland Health Benefit Exchange.

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For example, Maryland pushed through establishing legislation required for an exchange over a year ago. By comparison, only 14 states and the District of Columbia either have enacted state laws or administrative orders establishing an exchange.

Alan Weil, executive director of the National Academy of State Health Policy, said about 16 states have not done enough exchange planning to-date to run their own exchange plans “even if they want to.” About 20 other states have not decided whether they will pursue some exchange role—either a state-run or partnership exchange—and may have enough time to do that.

On Nov. 9, HHS extended a Nov. 16 deadline for states to submit their detailed “blueprints” for either state-run exchanges or partnership exchanges with the federal government. However, states must still submit letters that day stating their intent regarding exchanges.

“The final counts are not knowable yet, but we can state with confidence that a significant share of the country is going to be operating under a state-based exchange, a significant share under a federal exchange and a significant share under a partnership exchange,” he said.

The exchange discussion occurred at the annual conference of the National Business Coalition on Health, of which Modern Healthcare is a sponsor.

Meanwhile, the House Republicans continued their scrutiny of possible conflicts of interest that may arise in the federal and state exchanges with a letter requesting more details (PDF) on their implementation to HHS Secretary Kathleen Sebelius.


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