Last spring, the U.S. Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act but made participation in the expanded Medicaid program optional. The new flexibility with Medicaid expansion led many states announce that they'd opt out of the program—a decision with the potential to leave an estimated three million people uninsured, according to the Congressional Budget Office.
But PPACA also requires that states make insurance plans available for purchases through HIX by January 1, 2014.States must also demonstrate to the Department of Health and Human Services by January 1, 2013, that an exchange will be operational by 2014. If a state cannot meet that 2013 deadline, then the federal government has the authority to establish and operate an exchange for that state.
To encourage states to create their own HIX, the federal government has allotted about $1 billion to go toward research, planning, and technology for exchanges. Just last week, HHS Secretary Kathleen Sebelius announced that Arkansas, Colorado, Kentucky, Massachusetts, Minnesota, and the District of Columbia would receive one of the Affordable Insurance Exchange Establishment grants.
These six are among the 49 states, plus the District of Columbia and four territories, that have now received federal grant money to plan HIX; 34 of those states plus the District of Columbia have received grants to build an exchange. The ultimate goal is to allow consumers in every state to be able to buy insurance from qualified health plans directly through these marketplaces and to be eligible for tax credits to help pay for their health insurance.
Establishing a state exchange is a highly complex process, however—another reason several financial leaders at the HealthLeaders Media CFO Exchange expressed concern about how they might ultimately impact healthcare organization finances.
For instance, states must grapple with establishing governance and certification procedures, determining competitive standards among plans, and creating IT structures. Additionally these exchanges must develop small-business health plan options as well as plans that can take on a disproportionate share of high-risk, high-cost individuals that don't impose higher premiums on those individuals.