Posted on 11/25/2012 10:21:41 PM PST by Libloather
Obama faces huge challenge in setting up insurance exchanges
By Elise Viebeck - 11/25/12 02:45 PM ET
The Obama administration faces major logistical and financial challenges in creating health insurance exchanges for states that have declined to set up their own systems.
The exchanges were designed as the centerpiece of President Obama’s signature law, and are intended to make buying health insurance comparable to booking a flight or finding a compatible partner on Match.com.
Sixteen states — most of them governed by Republicans — have said they will not set up their own systems, forcing the federal government to come up with one instead.
Another five states said they want a federal-state partnership, while four others are considering partnerships.
It's a situation no one anticipated when the Affordable Care Act was written. The law assumed states would create and operate their own exchanges, and set aside billions in grants for that purpose.
“There's no way around it — this is a big job,” said Sabrina Corlette, a health policy expert at Georgetown University.
Since different states have different insurance markets and different eligibility requirements for Medicaid, Obama’s Health and Human Services Department can’t simply take a system off the shelf as a one-size-fits all failsafe.
"You can't simply deploy one federal exchange across the board," said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.
"Each state is different — their eligibility systems are different, their insurance markets are different. [HHS is] going to have to build these exchanges to fit into the context of each state."
Every state must have an exchange by Jan. 1, 2014, meaning HHS doesn’t have a lot of time to do a massive amount of work. The department could quickly run through a $1 billion fund designated for implementing the exchanges.
Experts have predicted that the department will soon have to tap budgets from its other programs to cover exchange costs. Other have said it might charge fees on the insurance purchased in its exchanges once they are launched.
And as it moves forward, the department will continue to deal with political battles. Speaker John Boehner (R-Ohio) on Wednesday said repealing Obama’s law should be one of the topics discussed in budget discussions in the lame-duck session.
The idea behind the exchanges is to match the uninsured with plans that meet their needs and reflect their eligibility (or not) for government help.
In practice, the process will require websites that can process massive amounts of personal information from users and yield search results for everyone.
An exchange portal might tell an uninsured woman she is eligible for a premium tax credit, for example, after processing her Social Security number and tax-return figures. Officials hope that woman would go on to compare relevant health plans available in her state and then enroll online.
Constructing these sites is just one task facing HHS when it comes to states that have decided not to do the job themselves.
Each portal will require a front end — the interface consumers will use to submit their information and shop for plans — and a specialized back end that is customized based on the state.
HHS will also construct a range of other systems: a federal data hub for verifying user identity; programs for user assistance; a way to certify that health plans meet federal standards; a way to navigate the exchanges via phone, or apply for coverage by mail; and so on.
While HHS has pushed back the cutoff points for states to choose how to run their markets, the department has indicated that the Jan. 1, 2014 deadline is holding firm.
“I personally haven't heard any discussion of a delay,” healthcare reform opponent Rep. Phil Gingrey (R-Ga.) recently told The Hill.
The administration faces challenges beyond the financial and technical, too.
The department has no knowledge of local insurance markets compared with state insurance regulators. It is also not likely to see its markets as a way to grapple with state-by-state health issues.
Dan Mendelson, CEO of consulting firm Avalere Health, gave obesity as an example.
“Say there's a really big obesity problem in a Southern state,” he said.
“If that state were running its exchange, it could say to insurers 'We want to make sure you have a plan that encourages diet and exercise.' Medicaid frequently does this. The program is always tailored to the specific needs of the state.
“By ceding the prerogative on their exchanges, states lose the opportunity to make those choices."
This might be the biggest difference between state- and federally-run exchanges, experts said, though consumers are not likely to notice as they shop for insurance.
“States that are moving forward with their own exchanges have a long history of regulating their insurance markets. These are states that are more likely to selectively contract with certain health plans," said Tolbert.
"States that are defaulting to a federally run exchange typically do much less regulation. If they had run their exchanges, they probably would have adopted a clearinghouse approach, which is what the federal exchange is going to do."
Experts expressed one main concern across the board — that people eligible for Medicaid but not for the exchanges might fall through the cracks in federally run systems, since enrollment in the program is run by states.
“That's the thing I'm most worried about,” said Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities.
“There has to be a smooth way to connect people with Medicaid.”
“Sixteen states — most of them governed by Republicans — have said they will not set up their own systems, forcing the federal government to come up with one instead.”
Any way of knowing which 16?
16 of 57 states...hard to tell.
;^)
These exchanges look like a massive dating mining operation for the federales
I’ve found these names so far in various articles. I hope they’re still correct:
Alabama
Alaska
Georgia
Indiana
Kansas
Louisiana
Missouri
Nebraska
North Carolina
Ohio
South Carolina.
Texas
Wisconsin
Cardinal Dolan and the USCCB which he heads still SUPPORT Obamacare.
This means that the bishops of my Church are my ENEMIES, because they support totalitarianism. They supported it for decades, including the four decades in which the U.S. Government has been in the hands of the pro-abortion eugenics movement. During that time, they have refused to declare that politicians who promote abortion are bad Catholics. During that time, the Popes have continued to appoint bishops to the U.S. who will not oppose the destruction of my country.
The Church to which I belong is committed to the destruction of my country.
http://www.cbpp.org/files/CBPP-Analysis-on-the-Status-of-State-Exchange-Implementation.pdf
According to the link, there are 19 states declining to participate.
AFAIK, North Dakota is one of the states refusing to set up an exchange.
You can add Maine to the list.
They will never ever make the 2014 deadline. We have had some HIPAA mandates which were to be effective beginning in 2012 which are still being postponed. Private insurance carriers are good to go but Medicare isn’t.
Your idea isn’t crazy at all IMO. People who want insurance are going to get it on their own, those that don’t won’t. I don’t mind so much everyone having to have some level of coverage what I object to is BO telling me what I need to have covered. Personally I think all policies should be high deductible and primarily for inpatient services only, no carve outs to third party, no case management for outpatient services and no networks. Cut out everyone in the middle. Most doctors I know and work with will negotiate outpatient fees if you want to pay cash and there is no insurance paperwork necessary. I also have a real problem with pre-existing conditions being covered. Probably partially because it’s something I don’t have to worry about, but also because there simply is not enough money in the world to cover everything for everybody.
I hear Romney's IT team is available.
bfl
and South Dakota makes nineteen.
“CommieCare”....better than “ObamaCare” because there are actually stupid people who believe he deserves credit for destroying our medical system and killing old people.
“No individual, company, business, nonprofit entity, or health insurance issuer offering group or individual health insurance coverage shall be required to participate in any Federal health insurance program created under this Act (or any amendments made by this Act), or in any Federal health insurance program expanded by this Act (or any such amendment), and there shall be no penalty or fine imposed upon any such issuer for choosing not to participate in such programs.”
http://www.coachisright.com/the-law-itself-says-virtually-no-one-has-to-participate-in-obamacare/
Does this work? It’s from the Obamacare law itself.
The lousy federal government hasn’t even made a decent beginning in writing the regulations for the 2500 pages of CommieCare. How in Hades is anyone going to implement an enormous system when the bureaucrats are still trying to figure out what they are doing? No wonder thousands of physicians are planning to retire when this disaster kicks in.
And we thought that Amtrak and the USPS were badly run. At least, they couldn’t kill our parents and children.
Virginia has got to be on that list.
The reason commiecare is a debacle is because it is about social engineering, not the delivery of good and affordable healthcare.
Commiecare was designed to kill off old people and seize the freedom of the younger people using their future health needs to bully them into submission.
This is what happens when communist dems get control. Everyone suffers.
Wonder why Florida isn’t on the list. I just picked up my retirement bunker down in beautiful red Lee County. Didn’t Pam Bondi and Florida lead the anti-commie care charge?
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.