WASHINGTON Dec 13 Only 15 U.S. states plan to
operate health insurance exchanges under President Barack
Obama's reform law, leaving Washington with the daunting
prospect of creating and operating the new online marketplaces
in at least two-thirds of the country.
On the eve of a federal deadline for states to say whether
they will run their own exchanges, 11 other states have informed
the administration that it should plan to be heavily involved in
setting up private health insurance markets within their
borders, said Gary Cohen, director of the Center for Consumer
Information and Insurance Oversight, on Thursday.
Experts say the number of states planning to operate their
own exchanges could reach 18 and the District of Columbia by the
time the deadline expires on Friday. But the administration
would still be left to set up exchanges in at least 30 states, a
challenge that is raising questions about how successfully U.S.
officials can implement a key provision of the healthcare reform
law known to advocates and opponents alike as "Obamacare".
But the Obama administration insists that exchanges will be
operating in all 50 states and the District of Columbia as
required by the law.
"All exchanges will be open for enrollment in October 2013,"
Cohen, who is overseeing implementation of the exchanges, said
in written testimony to a health oversight panel in the U.S.
House of Representatives.
States that don't run their own exchanges would opt for one
of two alternatives: a federally facilitated exchange that
requires minimal state participation, and a federal partnership
exchange in which states help by performing certain duties.
States have until Feb. 15 to say whether they intend to seek
a federal partnership exchange. Four have done so already, Cohen
The Patient Protection and Affordable Care Act, which Obama
signed into law more than 2-1/2 years ago, is expected to extend
health coverage to more than 30 million uninsured Americans
after it comes fully into force on Jan. 1, 2014.
About half of those newly insured would purchase private
coverage from online exchanges at federally subsidized rates.
Ultimately, the number of people expected to find coverage
through exchanges is expected to reach 26 million, according to
the nonpartisan Congressional Budget Office.
The remainder would be covered by expanding the Medicaid
program for the poor to cover all adults earning up to 133
percent of the federal poverty level, or about $15,000 for
individuals and $30,600 for a family of four.
To provide exchange coverage in multiple states, the
administration will have to erect an information technology
system capable of processing marketplace operations in a manner
customized to meet the needs of healthcare consumers in
Experts say the biggest challenge will likely be providing
adequate customer service to handle enrollment and fielding a
technology system capable of interfacing seamlessly with the
system of each state government.
Cohen told the House Energy and Commerce Subcommittee on
Health that the administration is building a website with
interactive capabilities and a call center and has begun testing
a data services hub designed to determine eligibility.