HHS Doing All It Can to Help States Establish Health Exchanges, Official Says

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By Steve Teske

The federal government is doing all it can to help states establish health insurance exchanges required under the health care reform law, and it will establish federally run exchanges in states that fail to act, a Department of Health and Human Services official said Oct. 18.

Speaking at a health care conference sponsored by the American Bar Association, Tim Hill, deputy director of the Center for Consumer Information and Insurance Oversight in the Centers for Medicare & Medicaid Services, said the exchanges are the “underpinning” of the Patient Protection and Affordable Care Act, and HHS has taken numerous steps to help states establish exchanges.

“We think we've done a lot … to help get states where they need to be,” Hill said.

Hill said HHS:

  • has issued five proposed rules related to the exchanges,
  • has issued grants to states to help them establish exchanges,
  • is establishing an electronic clearinghouse to help states get enrollee verification information, and
  • has issued guidance for incorporating information technology into exchange systems.

Hill said more guidance is expected regarding essential health benefits packages, health care quality, the beneficiary appeals process, and regarding basic health programs.

“They are all in the queue and ready to come out,” he said.

One-Stop Shopping

The exchanges, essentially one-stop shopping hubs for those looking for health care insurance and federal subsidies to help pay for it, are supposed to be in place by 2014.

Some states have complained that HHS has not provided enough guidance on establishing the exchanges and have claimed they may not have enough time to get them operational.

Hill said each state should establish its own exchange, because “one size is not going to fit all.” He said HHS will not hesitate to establish federal exchanges if states fail to act.

“We want this to be a state-based exchange, but we understand we have obligations” to step in if needed, Hill said. “We're going to bring up a federally facilitated exchange if we have to.”

States need to begin working on exchanges immediately if they are to have them operational by 2014, Hill said.

Time Running Short

An official from America's Health Insurance Plans told those attending the conference that it is going to be difficult for many states to get exchanges running in time.

Colleen Gallaher, vice president of state policy at AHIP, said state exchanges must be certified by HHS by 2013, leaving only 14 months remaining for states to pass legislation establishing exchanges and do the work needed following that to get them running.

“Fourteen months is hardly enough time,” she said. “It's really going to take all hands on deck.”

Gallaher said the open enrollment period for the exchanges likely will begin in October 2013, so exchanges must be ready for launch by June of that year. Complicating the work of establishing the exchanges are many other tasks required of them under the reform law, she added.

“The states have been slammed on implementation of the federal health care reform initiative,” she said.

Most state legislatures also will not convene until January 2012, leaving little time for state lawmakers to approve exchange legislation and for state officials to begin implementation work, Gallaher said.

Gallaher said 14 states have approved legislation establishing exchanges, while legislation is pending in Michigan, New Jersey, Pennsylvania, and the District of Columbia. Executive orders relating to exchanges have been signed by the governors of Indiana and Rhode Island, she added.

Attorney Kevin Woodhouse, with Ice Miller LLP in Indianapolis, told those attending the conference that the executive order in Indiana provides authorization only to study the establishment of an exchange.

Gallaher said the knowledge that the federal government will establish an exchange if a state does not may spur action by some states.

Hill said the exchanges will promote competition between health plans, lowering costs and increasing quality. The exchanges also will give those looking for insurance more plan choices, he said.

“It's got to work in order for the marketplace to work,” Hill said of the exchange system.

Hill also said HHS wants those seeking insurance to be able to do so via the internet in the same way they now purchase other items on the web. Recognizing that “there's going to be a lot of data floating around the exchanges,” Hill said HHS wants to protect sensitive data “to the highest extent possible,” he added.