State-Based Exchanges

Ten years ago, during the very first ACA Open Enrollment Period, Oregon was one of 15 states which attempted to operate their own fully state-based marketplace SBM) under the new law, calling it "Cover Oregon."

Cover Oregon was, along with several of the other original SBMs in Nevada, Maryland, Hawaii and (surprisingly) Massachusetts, a complete and utter failure. They flushed a stunning $248 million down the drain on a website portal which, put simply...didn't work. Like, at all. From April 2014:

Cover Oregon poised to switch to federal insurance exchange

Alex Pettit, the state's top information-technology official, recommended Cover Oregon move to the federal exchange at an advisory committee meeting Thursday.

Oregon should pull the plug on the beleaguered Cover Oregon health insurance exchange and switch to the federal exchange, a technological advisory committee recommended Thursday.

The move is considered almost certain to be adopted by the Cover Oregon board, which meets Friday.

Virginia

Last month the Centers for Medicaid & Medicaid Services (CMS) director of the Center for Consumer Information & Insurance Oversight (CCIIO...yeah, those names & acronyms just roll off the tongue, don't they?) informed the state of Georgia that they're gonna have to wait one more year before launching their own fully state-based ACA exchange (SBE) platform.

Georgia's insurance commissioner wasn't pleased about the delay, to say the least, but he agreed to bump the launch out another year even if he grumbled while doing so.

There were several reasons given for the 1-year delay, but many of them stemmed from the fact that Georgia was attempting to skip the "Federally-Facilitated" SBE phase which every other state which has made the transition to their own full state-based platform has undergone for at least one year.

Back in February, I wrote about how the state of Georgia, in an eyebrow-raising move, announced that they were moving from the federal ACA exchange (HealthCare.Gov) onto their own state-based ACA exchange.

While numerous other states have already done the same thing (and several more are in the process of doing so as well), Georgia's move to their own enrollment platform was especially noteworthy for two reasons:

First, because it represents as complete 180-degree policy turn from their prior attempts (over the course of several years) to eliminate any formal ACA exchange (federal or state-based) in favor of outsourcing it to private insurance carriers & 3rd-party web brokers.

Secondly, because of the timeframe involved:

Back in February, I wrote about how the state of Georgia, in an eyebrow-raising move, announced that they were moving from the federal ACA exchange (HealthCare.Gov) onto their own state-based ACA exchange.

While numerous other states have already done the same thing (and several more are in the process of doing so as well), Georgia's move to their own enrollment platform was especially noteworthy for two reasons:

First, because it represents as complete 180-degree policy turn from their prior attempts (over the course of several years) to eliminate any formal ACA exchange (federal or state-based) in favor of outsourcing it to private insurance carriers & 3rd-party web brokers.

Secondly, because of the timeframe involved:

Back in February, I wrote about how the state of Georgia, in an eyebrow-raising move, announced that they were moving from the federal ACA exchange (HealthCare.Gov) onto their own state-based ACA exchange.

While numerous other states have already done the same thing (and several more are in the process of doing so as well), Georgia's move to their own enrollment platform was especially noteworthy for two reasons:

First, because it represents as complete 180-degree turn from their prior attempts (over the course of several years) to eliminate any formal ACA exchange (federal or state-based) in favor of outsourcing it to private insurance carriers & 3rd-party web brokers.

Secondly, because of the timeframe involved:

Illinois

I wrote about Illinois House Bill 579 back in March:

...With the recent trend of more & more states (most recently including Georgia) splitting off from the Federally Facilitated Marketplace (FFM) hosted via HealthCare.Gov, it's hardly surprising...but it's still a pretty big deal, especially given that Illinois is the 6th largest U.S. state by population. Via Amy Lotven of Inside Health Policy:

Illinois’ Department of Insurance would be authorized to operate a state-based exchange, starting in plan year 2026, under legislation introduced late Thursday by the Illinois Democratic House Majority Leader Robyn Gabel. Sources earlier this week told IHP they had heard state officials were working with lawmakers on exchange legislation and the bill could be unveiled by this week.

In February, I wrote about how the state of Georgia, in an eyebrow-raising move, announced that they were moving from the federal ACA exchange (HealthCare.Gov) onto their own state-based ACA exchange.

While numerous other states have already done the same thing (and several more are in the process of doing so as well), Georgia's move to their own enrollment platform was especially noteworthy for two reasons:

First, because it represents as complete 180-degree turn from their prior attempts (over the course of several years) to eliminate any formal ACA exchange (federal or state-based) in favor of outsourcing it to private insurance carriers & 3rd-party web brokers.

Secondly, because of the timeframe involved:

4/01/23: See important update at bottom.

Back in early February, I wrote:

If this was any other state besides Georgia--even any other GOP-controlled state--I'd say good for them since it would presumably just mean that they were the latest state to move to their own state-based exchange (which is how the ACA was originally envisioned anyway).

This would give them the ability to hook the SBM into their state databases for auto-enrolling residents receiving SNAP benefits/etc into $0-premium coverage, or to integrate supplemental subsidies as nearly a dozen states do today, and so forth. There's several upsides to moving to an SBM, up to & including reducing the user fees (although those have been significantly reduced on the federal exchange in recent years anyway).

Illinois

I had heard that this was in the works, and with the recent trend of more & more states (most recently including Georgia) splitting off from the Federally Facilitated Marketplace (FFM) hosted via HealthCare.Gov, it's hardly surprising...but it's still a pretty big deal, especially given that Illinois is the 6th largest U.S. state by population. Via Amy Lotven of Inside Health Policy:

Illinois’ Department of Insurance would be authorized to operate a state-based exchange, starting in plan year 2026, under legislation introduced late Thursday by the Illinois Democratic House Majority Leader Robyn Gabel. Sources earlier this week told IHP they had heard state officials were working with lawmakers on exchange legislation and the bill could be unveiled by this week.

 

It's particularly embarrassing for me to not have had this development on my radar seeing how I'm a life-long Michigander who also personally knows at least two of the state legislators onboard. Regardless, this is pretty exciting news from a healthcare policy wonk perspective:

The Michigan Legislature is considering joining the 18 other states that have established state-run health insurance marketplaces through HB 6112. Having an exchange run by the state instead of the federal government, supporters of the bill say, will save Michiganders money by leaving the “rigid and inflexible” federal market for a Michigan-tailored market that can be more responsive and potentially lower premiums. The bill is still in the early days of the legislative process, awaiting a vote from the House Health Policy Committee.

Sure enough, from last week:

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