Payers' Role in Health Insurance Exchanges Unclear

Even though states have chosen how they will set up their federally mandated health insurance exchanges, there is still a lot of uncertainty over what exactly consumers will be buying when open enrollment comes around October 1, 2013.

By last week's December 14 deadline, half of the country's governors had rejected setting up a state-run insurance exchange and instead opted to hand over the responsibility to the federal government. Health insurance exchanges will be run by a federal-state partnership in seven states, while the remaining 18 states along with Washington D.C. plan on having a state-based exchange.

Sonya Schwartz, program director for the National Academy for State Health Policy, says she was "not at all surprised" so many states opted out of running their own exchanges. "I'm a little surprised more [states] aren't doing the partnership. I think that's mostly politics, but I wasn't surprised at all that so many decided not to do it."

So far, nine of the states running their own exchanges have received conditional approval from HHS, and of those, Schwartz says the three states, as well as Washington D.C. are furthest along in planning: California, Colorado and Vermont.

These states, she says, have requests out for proposals for health plans to meet their qualifications to participate. "They have pretty strong sense of how they're going to be certifying health plans and what's going to be required."