Payers' Role in Health Insurance Exchanges Unclear

Every state committed to running its own exchange is taking a different approach.  Colorado, says Schwartz, is offering something akin to a free-market plan. "They are not going to be selectively contracting with plans," she says. "They have federal standards in place and plans are going to come in and they're going to have to meet that floor."

California's approach, on the other hand, is an active user model. That state got out front early with its exchange called, "Covered California," and is planning a big marketing push to enroll members, which Schwartz says is key to having a successful health insurance exchange.

"It's not just the amount, it's who. If you roll out the program, and you don't market it very well, you may only get the people who need healthcare now;  [those] who are sick; who are old; who have issues. What you really want to do is reach also the people who will need healthcare...  but maybe don't have such an urgent need, and maybe are a little younger, and who really seize the opportunity to get this federal subsidy to buy healthcare."

The way state-federal partnerships will work became a little clearer this month with some guidance from HHS.

In essence, Schwartz says, the federal government will build the infrastructure states use to help determine members' subsidies, plan costs, and plan options, which she says will help states a lot because developing the infrastructure is "such a heavy lift."