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Ready or not
Exchange preparedness varies in GOP-led states

By Maureen McKinney
Posted: September 28, 2013 - 12:01 am ET

State-based Republican opposition to implementation of the healthcare reform law forced federal officials to scramble over the past six months to design and launch far more local health insurance exchanges than originally anticipated.

And while HHS last week touted the broad consumer choice and lower-than-expected premiums for the health plans that will be available on those exchanges, local officials are reporting widely varying levels of competition and preparedness in advance of the Oct. 1 start of open enrollment.

In Indiana, for instance, four insurers—MDwise, Coordinated Care, Physicians Health Plan of Northern Indiana and Anthem Blue Cross and Blue Shield—will offer plans on the state exchange, pending final HHS approval, said Dennis Rosebrough, a spokesman for the state's department of insurance. But 31 of the state's 92 counties will have offerings from only one of those insurers. Thirty-five counties will have offerings from two issuers.

Seventeen insurers in Indiana's individual market have exited since March 2010 because HHS refused to exempt insurers from the Patient Protection and Affordable Care Act's medical-loss ratio rule through 2014, Rosebrough said. Stephen Robertson, the state's insurance commissioner, had told HHS that not granting the exemption would severely limit consumer choice of health plans. HHS replied that it did not find a reasonable likelihood that the medical-loss ratio would destabilize the state's insurance market.

In Florida, 11 insurers, including Cigna Corp. and Humana, have sought qualified health plan certification. Twenty-one of the state's 67 counties, however, will have only one company offering health plans on the individual market, according to the state's office of insurance regulation.

Molina Healthcare, a Long Beach, Calif.-based managed-care insurer operating in Florida, will offer plans in only three heavily populated South Florida counties—Miami-Dade, Broward and Palm Beach—but plans to expand to other counties in 2015, said Steve Snider, Molina's director for membership growth. “I think it will build momentum as people get less afraid and grasp it for what it is,” Snider said of the state's exchange.

Florida Blue, on the other hand, will offer plans in all the state's counties, said Mark Wright, a company spokesman. The company has ramped up its outreach efforts with retail centers in strip malls where consumers can seek out information.

Some smaller health plans are viewing the opening of the exchange as a way to boost membership in states dominated by larger carriers. They'll be listed side by side with the giants on the insurance exchange's website and may offer lower premiums.

“We're excited about it,” said Jessica Self, a compliance coordinator at Vantage Health Plan, a small insurer based in Monroe, La., which is one of four insurers expected to offer plans on Louisiana's federally facilitated exchange. “We see this as a real opportunity.”

Michigan, which is partnering with HHS to run its state exchange, will offer plans from 13 insurers, including Blue Cross and Blue Shield of Michigan. The Blues plan will offer insurance options in all of the state's 83 counties. “I think we're one of the more competitive states in terms of offerings,” said Terry Burke, Blue Cross and Blue Shield's vice president for individual business. “Michigan had a pretty solid response from carriers.”

The feds' task is far from over now that the exchanges are mostly ready to go (expect a few glitches, the president said). In most states where Republican governors and state legislators have strongly opposed the healthcare reform law, they've gone so far as to prohibit involvement by state officials in exchange implementation and put up barriers to enrollment activities.

Alabama, for instance, will forward all questions to HHS related to the state exchange and the three insurers expected to compete on it, said Mark Fowler, government relations manager for the state's insurance department. “If it is related to an issue we would normally deal with, we will field those calls,” he said. “Any questions specifically related to the exchanges we will forward to the federal government.”

—with Harris Meyer and Jessica Zigmond

Follow Maureen McKinney on Twitter: @MHMMcKinney

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