While the small number of states operating their exchange in partnership with the federal government can take some responsibility for reviewing rates and recommending which plans should be on their exchange, all health plans in states with federally facilitated exchanges must receive final certification from HHS to be sold through the marketplaces. Some of the factors HHS is considering are whether the plans meet state insurance regulations, including being licensed in a state, and whether the insurer has a history of unjustified premium increases.
Whether the delay in signing contracts will affect the start of open enrollment in those 35 states is an open question. Some observers say that since actual exchange plan coverage, including federal subsidies, doesn't start until Jan. 1 and most Americans are not required to have coverage until then, most exchange enrollment activity will take place closer to that time, giving the exchanges a grace period of a couple months.
Robert Laszewski, a former insurance executive and president of Health Policy and Strategy Associates, a Washington-based consulting firm, said the delay was incremental in nature and not likely to delay the opening of the exchanges. “The real question,” he says, “is what's next and how many more delays will there be?”
America's Health Insurance Plans, the insurers' trade group, sounded supportive of the delay. “Health plans are doing everything they can to ensure open enrollment goes as smooth as possible when the exchanges launch on Oct. 1,” AHIP spokesman Robert Zirkelbach said. “Given the size and scope of the changes required by the law and all of the work that still needs to be done prior to open enrollment, it is not surprising that some things may be delayed and that there are glitches that need to be worked out. Health plans will continue to work with the administration and other stakeholders to implement these reforms in a manner that will be least disruptive for consumers and small businesses.”
But Sen. Lamar Alexander (R-Tenn.) said “the avalanche of last-minute delays should make every American anxious about the quality of the healthcare they'll be able to purchase in October and the security of the information they'll have to provide—proving again that this law must be repealed so that we can pass step-by-step reforms that transform the healthcare delivery system by putting patients in charge, giving them more choices, and reducing the cost of healthcare so that more people can afford it."
Last month, Alexander and several other senior Senate Republicans pressed the administration to release rate information from more states, including those with federally facilitated exchanges, after the administration released a report highlighting rates in 11 states.
In June, the Government Accountability Office warned that the Oct. 1 start of open enrollment in states with federally facilitated exchanges could be delayed due to a series of missed deadlines by the federal government.
Some state-run exchanges also have announced delays. Earlier this month, Oregon said that it wouldn't have its exchange ready until mid-October at the earliest, though residents could enroll starting Oct. 1 through brokers or agents. And on Aug. 22, Peter Lee, executive director of Covered California, that state's exchange, told members of the exchange's board that people might have to enroll offline starting Oct. 1 and that the exchange would phase in online enrollment.
Follow Jonathan Block on Twitter: @MHjblock
