(This blog originally appeared in the Health Policy Hub.)
By Christine Barber, Community Catalyst
Federal or state Exchange? The question of who should run
the marketplace for individuals and small businesses to shop for and buy
affordable, high quality insurance has been an ongoing debate in
health reform circles for a number of years. And a main decision point under
the ACA is whether a state will create and run its own Exchange or have the
federal government run the Exchange. To date, 12 states have passed laws to
create their own Exchanges. Advocates in other states face a difficult calculation about what will be best
for consumers – a federal or state Exchange – because so much is unknown about
what a federal Exchange would look like. So far, HHS has provided few details.
Recent proposed regulations from HHS rejuvenated the
discussion about federal Exchanges. HHS announced a “partnership model,” where
states could split certain Exchange duties with the feds. With little detail in
the regulations, states spent a few weeks dreaming about only working on parts
of the Exchange that appealed to them, and leaving the rest for HHS to deal
with. This lack of information about the partnership models made advocates, who
are concerned with the seamlessness of enrollment for consumers, rightfully
Last week, the Center for Consumer Information and
Insurance Oversight (CCIIO) unveiled further information on Exchange
partnerships through this PowerPoint at
a meeting of state officials. And the good news is that CCIIO is providing
striking clarity on the Exchange: either a state creates an HHS-compliant
Exchange by 2013 or the federal government will run the Exchange.
Under the federally-run Exchange, a state has a few
options for partnerships. For each of these, HHS would run the enrollment and
eligibility functions for the Exchange, and therefore the coordination with
1. State Consumer Assistance Partnership: A state would
maintain control and oversight of the Navigator program and other direct
assistance to help people enroll in health insurance, including outreach and
education. But HHS would oversee the website and call center for the Exchange.
2. Plan Management Partnership: States will oversee the
health insurance plans in an Exchange, including information and monitoring
about the health plan options. HHS would coordinate on oversight of health
plans and consumer complaints.
3. States could choose both the Consumer Assistance and
Plan Management Partnerships.
HHS was clear that, at this point, a state does not have
an option to run only a Small Business Health Options (SHOP) Exchange, and have
HHS run the individual Exchange, an idea explored by some states. A few things
remain unclear about the federal partnership models, including how financing
these Exchanges will work. More information from HHS can be found here.
We think these models could work for states, but
Community Catalyst is interested to hear what you think: are the new
partnership models going to be good for consumers?