The outlook for the establishment of state-run health insurance exchanges may be neither as rosy as their supporters claim nor as dark as their critics expect.
Even as several states recently rejected the insurance marketplaces required by the 2010 U.S. healthcare overhaul, federal regulators laid out a path that will make it easier for states to change their minds and give more time for them to do so. The combined effect of the disparate federal and state actions indicates that state-run exchanges are less likely in the original time frame of 2014 and more likely over a longer period.
Federal officials acted last week to allow a go-slow approach for state-run exchanges. A “draft blueprint” for state exchanges issued May 16 appeared to extend a hard statutory 2015 deadline for state exchanges to attain fiscal self-sufficiency to early 2018. That was the implication of the plan's announced availability of exchange implementation grants throughout 2014 and for three years to spend money that they could receive up to 2015.
“What that suggests is that a slower ramp-up is permissible,” said Bruce Caswell, president and general manager of the health services segment for Maximus, a Reston, Va.-based government contractor.
The extended time frame, details of which an HHS official said will be clarified in future guidance, came as part of new exchange guidance that emphasized a greater federal role over the next couple of years. For example, the documents established a Nov. 16 deadline for states to submit their plans if choosing to operate their own exchanges or a state-partnership exchange together with HHS. If state plans fall short of the new requirements, then the federal government will run part or all of the exchange until the state is ready to ramp up its own version.