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A Day Of Stark Differences For States On Health Insurance Exchanges

On the same day HHS Secretary Kathleen Sebelius granted conditional approval to Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington for their health insurance exchange plans, the Republican-dominated Florida Senate made its position on the insurance marketplaces known. Friday is the deadline for states to decide if they want to build and operate their own exchanges or have the federal government do it. The online insurance marketplaces are supposed to start signing people up in October 2013 for policies that begin in January 2014.

Here are two dispatches from reporters in the field:


Exchange officials  gave their first estimates of how much it will cost to run and floated potential revenue streams.

“We’re targeting a range of $22-26 million (annually) to run the exchange,” said Patty Fontneau, the CEO of the Colorado Health Benefit Exchange.

The exchange board expects about 250,000 Coloradans to get insurance through the exchange in its initial years. Exchanges are designed to help individuals and small businesses shop for coverage. The board is contemplating charging people a fee to pay for operations, either directly or via a per-enrollee fee on insurers selling in the exchange.

The state law establishing Colorado’s exchange forbids the state from spending general fund revenue on the exchange.

The exchange board has the authority to impose enrollment fees on users with the approval of just one legislative committee. A vote by the full legislature would be required to get money from a second potential source: the state’s high risk health insurance pool. Those in the high risk pool will be transferred to the exchange in 2014, and there’s sure to be a scramble for the state funds now being spent on that program.

Fontneau says Colorado hopes to have its method for funding the ongoing operation of the health insurance exchange finalized “probably within the next six months.”

– Eric Whitney, Colorado Public Radio


The Florida Senate on Monday launched a webpage about the federal Affordable Care Act and reiterated that the state will not run a health insurance exchange in January 2014.

House and Senate leaders have already said the state cannot make a decision on an exchange until the 2013 legislative session. A question-and-answer section of the new webpage made clear the state wouldn’t be ready to run an exchange in 2014, even if it wanted to do so.

Federal officials initially set a November deadline for states to say whether or not they would run their own exchanges, but then the feds gave states another month. “Florida, and several other states, did not submit a letter to the Secretary of Health and Human Services by the November deadline to indicate an intention to operate a state based exchange for health care coverage in calendar year 2014,” the new Senate webpage says. “Another deadline is set for December 14, but Florida’s position is unlikely to change at that time.”

Florida and other states have until mid-February to say whether they will set up their exchanges in partnership with the federal government. In that model, states would keep control of some functions of the exchange , such as deciding which companies can sell there, while the federal government oversees other functions.

– Jim Saunders, News Service of Florida