Two-thirds of Americans who sign on to buy health insurance using new state marketplaces will actually be getting a federally administered plan, a health consultancy firm projected Thursday.
Only 17 states, plus Washington, D.C, have said they will run their own health insurance exchanges or share responsibility with the federal government.
“These states are expected to enroll 2.8 million individuals out of a total of 8.2 million people nationwide who will buy coverage through exchanges in 2014,” Avaleere said in its report.
The rest have either said they’ll leave it up to the federal government, or are leaning that way.
Friday is the deadline for states to say for sure what they plan to do and just three states – Florida, North Dakota and Indiana – have failed to give an answer so far. But all three have governors who have indicated they won’t be setting up exchanges.
On Wednesday, Pa. Gov. Tom Corbett said his state would leave it up to the federal government.
Republicans who control the House Energy and Commerce Committee’s health subcommittee held a hearing on Thursday to highlight state reluctance to take part in the exchanges, even though they got their deadline extended by a month.
But the Health and Human Services Department said it didn’t matter – people will be able to sign up to buy health insurance on the exchanges as scheduled, in October 2013. Their coverage will start on the first day of 2014 under the 2010 health reform law.
“I am confident that sates and the federal government will be ready in 10 months," Gary Cohen, director of the Center for Consumer Information and Insurance Oversight, which is in charge of the new exchanges, told the hearing.
HHS said earlier this week that six states -- Colorado, Connecticut, Massachusetts, Maryland, Oregon, and Washington – are on track to have their health insurance exchanges approved. California, Hawaii, Vermont, Mississippi, Kentucky, Minnesota, New York and Rhode Island are also on board to run their own, Cohen said. Delaware, Illinois, Iowa and North Carolina want federal-state partnerships.
One of the main goals of the 2010 Affordable Care Act is to get more Americans covered by health insurance. About 15 percent of the population currently goes without, and most experts agree that people without health coverage delay routine medical care until they develop expensive-to-treat conditions. Hospitals and taxpayers often end up footing their bills.
The main way the health care law will get these people covered is on the exchanges. They’re designed to be a kind of online marketplace where people and small businesses can compare different insurance plans available in their states, choose a level of coverage, and find out if they are eligible for federal government subsidies to pay the premiums.
Cohen said HHS is on track to make this as easy as possible. “For example, we are building a website with interactive capabilities and a call center. Consumers will be able to use this to compare qualified health plans, check their eligibility for affordability programs, and enroll in a qualified health plan,” he said at the hearing.
Even if the federal government runs the exchanges, they’ll be subject to state-by-state variation. That’s because state law still determines which insurance companies can sell products within a state’s borders. States also can decide whether to expand Medicaid, the state-federal health insurance plan that now covers mostly the very poor and pregnant women without insurance.
But representatives from several states said the process has been far too confusing and they fear HHS will make an already complicated process even more complex.
“In all my years of public service, I have yet to witness a law so vast with such breathtaking scope, demands on state resources, and lack of federal guidance,” Gary Alexander, Pennsylvania's secretary of public welfare, told the hearing.
“I have hundreds of policy, operational, and technical staffers working to implement this health-care reform law, and yet, we realized early on that we do not have the capacity or the financial resources to address all of the provisions and requirements of this complicated law.”
Bruce Greenstein, Louisiana’s health secretary, echoed this. “We have repeatedly shared our concerns regarding its policy implications, lack of sufficient guidance and unreasonable timelines for implementation,” he said.
Cindy Mann, deputy administrator at the Center for Medicare and Medicaid Services, said HHS had held constant briefings to help guide states. “We are on the phone literally every day with people form the states, helping them, answering their questions,” she told the hearing.
Dr. Joshua Scharfstein, who heads Maryland’s health department, agreed. “We have had a terrific interaction,” he told the hearing, saying he has been “really impressed” with Cohen’s and Mann’s departments.
Democrats on the subcommittee accused Republicans of playing politics and said critics of the health reform law were still trying to undermine it, even though the U.S. Supreme Court ruled it constitutional in June.
“Many of us fear is the purpose of this hearing is to show we can’t move forward,” said California Democrat Henry Waxman. “That’s flat-out wrong. It seems to me it’s just the latest attempt to repeal the Affordable Care Act.”