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Few States Choose to Operate Health Insurance Exchanges

Doug Desjardins, February 15, 2013

Political issue
The question of states establishing or not establishing a health insurance exchange has become a political issue.  Most states that oppose the PPACA have rejected them outright while states like California began preparing their exchange plans a few months after the PPACA was passed in 2010.

"Unfortunately, the issue has become politicized and that's made the job of establishing exchanges more difficult," said Sam Karp, vice president of programs for the California HealthCare Foundation (CHCF).

The CHCF and several major non-profit groups - including the Robert Wood Johnson Foundation and the New York State Health Foundation - pooled their resources in a $3 million project to create Enroll UX 2014, a template that state and federal officials are using to create their own exchanges. The CHCF contributed $1.5 million to the project and served as managing partner in a major undertaking that included input from 11 states, the Centers for Medicare and Medicaid Services (CMS), and the Office of the National Coordinator for Health Information Technology. The CHCF unveiled the free Enroll UX 2014 template in June 2012.

"It was a bi-partisan effort that included states like Alabama and Tennessee, which have decided not to set up their own exchanges but will leverage some of the design elements of Enroll UX to improve their online Medicaid websites," said Karp. "And that's the goal of the program; to provide states with a starting point and some ideas about how an exchange can work."

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