No More Reason to Delay Health Insurance Exchanges

November 8, 2012 at 4:55 pm

For months, many state leaders who oppose health reform have delayed implementing the parts of the law that fall under state purview — most notably, planning the new “exchanges” (or marketplaces) that will allow families and small businesses to shop for affordable health plans.  Now that this week’s election results suggest that health reform is here to stay, states that have dragged their feet need to get to work.

Several states have made significant progress towards launching their exchanges by the October 1, 2013 start of open enrollment.  Many others have held back, as we’ve tracked here.  But it’s not too late for a state to act.

States have three options:

  • build a state-based exchange;
  • let the Department of Health and Human Services (HHS) design and operate an exchange in the state; or
  • enter a partnership agreement with HHS in which HHS designs the exchange but the state helps operate it.

States must submit their proposal for HHS approval by November 16.  While that probably precludes a lot of states from developing a state-based exchange for 2014, they can still consider creating one in 2015 after having a federal exchange in the state for a year.  They also have time to refine plans to pursue the partnership option, in which the state oversees critical functions like health plan management and consumer outreach.

States that want to operate an exchange face a lot of decisions and tasks between now and when it must launch in October 2013.  They need to build a user-friendly application process, determine which health insurance plans will be sold, organize outreach and education plans, and set up a call center and programs for in-person assistance to consumers.

Consumer groups in the states have been making recommendations in these areas, and leading states have designed policies that could serve as examples to latecomers.  HHS has repeatedly said that it will help any state interested in building an exchange.  But it’s up to each state to decide whether it wants to have any role in establishing its exchange.

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More About Dave Chandra

Dave Chandra

Dave Chandra is a Senior Policy Analyst at the Center on Budget and Policy Priorities in the Health Policy Department.

Full bio | Blog Archive | Research archive at

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