During the last few weeks, many HIMSS members have asked me about the part of the Affordable Care Act that establishes Affordable Insurance Exchanges (Exchanges) to offer individuals and small business employees with access to health insurance coverage beginning Jan. 1, 2014. I think this interest on behalf of our members might be a result of two dates in November that could have a bearing on the future of the Exchanges.
The most recent information I have found on the status of the Exchanges in the states is:
- 16 states have established State Exchanges;
- 3 states are planning for a Partnership Exchange;
- 16 states are still studying their options;
- 9 states have not had any significant activity on the Exchanges; and
- 7 states have decided not to create a State Exchange.
The states face a Nov. 16 deadline set by the Affordable Care Act that calls for proof of ability to establish Exchanges, or the federal government will step-in and set them up. But the officials in some states, who are trying to implement these Exchanges and meet the Nov. 16 deadline, are being delayed by their fellow elected officials, who will not determine their support for establishing Exchanges, until after Nov. 6, Election Day.
The election scheduled for Nov. 6, and the deadline 10 days later, has caused some angst for officials in states that have Republican governors and legislators. This group wants the states to do nothing until the national election on Nov. 6, hoping the party wins enough votes, and they can, with a new congress and administration, repeal the law.
As many states are progressing to establishing Exchanges, they are all doing so at different paces. Some have already applied for multi-year funding, while others are moving in the direction a bit slower.
States can choose when to apply for grant funding based on their needs and planned expenditures.
- States moving ahead on a faster pace can apply for multi-year funding, known as level-two establishment grants.
- States making progress in establishing Exchanges through a step-by-step approach can apply for funding for each project year, known as level-one establishment grants.
States may initially apply for either level one or level two establishment grants, based on their progress.
States can also choose when, during this year, to apply for grant funding, based on their needs and planned expenditures. States will have multiple opportunities to apply for funding in the years ahead, including opportunities to apply for multiple level-one grants as the planning process develops.
CMS has indicated it intends to award Exchange Establishment grants through 2014. This process gives states maximum flexibility and ensures that states can move forward on their own timetables, as they work to build an Exchange.
Each state’s insurance market is unique, and each state will need different levels of support, as it creates an Exchange. Each state’s grant awards were made following a thorough examination of funding requested by the state, and an analysis of what would be a reasonable funding amount from the federal government.
With the Nov. 6 election just over 30 days away, if it hasn’t done so yet, do you see your state finally establishing an Exchange, if the president is re-elected?