Dive Brief:
- To date, all 14 of the states running their own health insurance marketplaces have had their costs paid for by the federal government, but they're supposed to begin carrying their own costs by next year.
- In several states where enrollment is lower than expected, it's not clear whether insurance surcharges set up to sustain the state exchanges will be enough.
- To become financially self-sufficient, some are reserving money from federal grants to pay for operations past January 2015. Others are considering staffing cuts or pushing up insurance surcharges.
Dive Insight:
If state exchanges don't become financially independent by the January 2015 deadline, it could play hell with the marketplace concept generally. So far states have received almost $3.8 billion to start and run their exchanges; that money sounds like it's going to be hard to replace through surcharges. It could be that the whole state exchange business model needs to be reworked if states are going to be successful at keeping their exchanges afloat long term.