art: barbara etzkorn

state of the states: insurance exchanges

what the states are doing now to make their
health insurance exchanges flourish or flounder

know your exchange: ● What states are doing ● Assess your exchange ● Federal exchange option ● Costs remain unclear ● More ACA protections likelihood of state operation: Active or Likely (In operation already or likely to be state-operated) CA  CO  CT  HI  IL  MA  MD  MS  NV  NC  ND  OR  RI  UT  VA  VT  WA  WV  WI  WY  Pending (Likely to be state-operated, but awaiting legislation) AK  AL  AZ  AR  DC  DE  GA  ID  IN  IA  KS  KY  ME  MI  MN  MO  MT  NE  NH  NJ  NM  NY  OH  OK  PA  SC  SD  TN  TX  Unlikely (Likely to be federally operated) FL  LA

By Jan Greene
healthinsurance.org™ contributor

Consider the health insurance exchange – it would appear to be an arcane, technical concept that only an actuary could love. And yet, this core provision of the federal health reform law has become a hot topic, taken up by vociferous opponents of "Obamacare" as another dart to fling at reform to deflate it once and for all.

The average insurance consumer could be forgiven for throwing up her hands at the political flamethrowing and ignoring the whole debate over exchanges. But that would be a mistake.

Because the exchange – envisioned as an easy-to-use, online insurance marketplace for consumers who need an individual health plan – is the heart of health reform and the piece that will impact consumers most directly.

In theory, using an exchange could be much simpler than the current way that people buy insurance (for the approximately 15 percent of the U.S. population who don't get coverage from an employer, Medicaid or Medicare). Right now, consumers have to dig through technical jargon and complicated premiums, copays, deductibles and hidden exclusions to compare one plan with another.

As envisioned by the federal health reform law, an online exchange would have simple, side-by-side comparisons of health plans. Depending on how the exchange is set up, it could also prescreen the health plans available to make sure they are comprehensive and as affordable as possible. The exchanges could pull together large groups of people – such as combining both individuals and employees of small businesses – to make a bigger pool and keep prices down.

Each state is supposed to have an exchange up and running by 2014, or leave its state's consumers to use a federal exchange instead.

But at this stage of the game, states are all over the place on adopting and implementing exchanges. Some states are far ahead of others on designing their exchanges, while a few have refused to participate at all, for political reasons.

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