Dive Brief:
- State health insurance exchanges established under the ACA are continuing to struggle to sustain operations, leading some to work with HealthCare.gov (Hawaii, Nevada and Oregon) and others to discuss regionalizing efforts with other states.
- There is no longer pressure for states to maintain exchanges following the SCOTUS ruling that health insurance enrollees qualify for premiums through the federal marketplace as well.
- Sustainability will be the main focus of the Obama administration's annual meeting with state exchange directors, scheduled for the end of the month.
Dive Insight:
There are now 12 states and the District of Columbia that fully control their health insurance markets, and about half are estimated to be facing financial struggles.
While going to the federal exchange is always an option, some states may prefer to find a middleground in which they pool or outsource some functions but maintain control over key aspects such as marketing, consumer education and oversight of health plans.
With the issue of subsidies out of the way, "I think you are going to see much more of a hybrid across the nation," Covered California's Peter Lee told the Associated Press. States are talking about shared services, he says, in order to achieve economies of scale, and there is discussion in New England of creating a regional exchange.
Some in the insurance industry say they would welcome consolidation of exchanges.
"Our biggest concern is that you may see many states looking to enact taxes and fees, and that makes health care less affordable," Justine Handelman, policy chief at the Blue Cross Blue Shield Association, told the AP.