The New Year brings us optimism, good spirits and hope that America will be one step closer to equality in health care. Over the holidays, states and the Department of Health and Human Services were hard at work developing the health insurance exchanges, or in other words, an easier way for certain individuals and small business owners to purchase health insurance.
The exchanges must be ready by October 2013 for enrollment and be fully operational by January 2014. Yes, that’s optimism at its finest. In mid-December 2012 states had to decide if they were going to run the exchanges themselves or use the government plan. Though, until February 15, 2013 states can still opt for a federal partnership. So far, 19 states decided to operate the exchange themselves, seven decided to receive some help from the government and 25 have defaulted to a federal exchange.
Basically, exchanges are going to be organizations (either a government agency or a non-profit) that will help make finding health insurance simple and straightforward and will keep prices competitive among plans. Massachusetts already has had a great functioning exchange since 2007 called Health Connector. Utah also has had a functioning exchange since 2009 for small businesses but will need to expand to individuals.
All exchanges, state-run or not, will need to meet minimum standards set by the Affordable Care Act which includes hiring ‘navigators’ for assistance, client education, basic health benefits, maintaining a website, and rating health insurance plans. All exchanges must offer two plans and one must be from a non-profit. Ideally, if you are looking for insurance you’ll be able to go onto a website, browse plans, have all your questions answered either online or by phone and be enrolled with an affordable plan that fancies you within 30 minutes. Good thing it’s January so we’re all feeling extra optimistic! By 2014 people who don’t have employer health insurance (those with lower incomes will receive subsidies) and small business with up to 100 employees will be able to find health insurance plans through an exchange. By 2017, states can decide if they want to offer exchanges to larger employers.
Originally, the intent was for exchanges to all be state-run since state legislatures probably know what works best for them as far as setting eligibility, plans and funding. It was expected that only states with small populations would default to a federal exchange, but the two most populous states with 20 percent of the nation’s uninsured, Texas and Florida, have opted for the default.
Most states that chose to have a federal Exchange did so early in advance claiming that the exchanges would be too expensive or to try to sabotage Obamacare since they don’t agree with the law. All but four states received grants to help offset costs which mainly went to hiring IT work. The states with partnership exchanges will be able to manage plans and customer service and the hope here is that the Department of Health and Human Services will try to work with states as much as possible to individualize the exchanges so that all states will have the opportunity to move to a state-based model in the future.
The irony here is that the Republican states that chose a federal exchange are going against their fundamental Republican ideals. They complain that Obamacare is big government but they certainly don’t seem to have a problem making government’s role bigger in this case. I’m staying optimistic though, the world didn’t end, Obamacare is in full effect, Republicans can still flip-flop on exchanges and I’m hoping people will remember once again George Washington’s warning in his farewell address of damaging divides due to partisan political spirits.
