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Implementing exchanges presents challenges for HHS

healthins exchanges Implementing exchanges presents challenges for HHSThe health insurance exchanges were designed as the backbone of PPACA, with the intent of creating an online portal for Americans to purchase affordable health insurance.  The Obama administration now faces significant logistical and financial challenges, since some states have declined to setup their own exchanges and the Federal government does not have the expertise or infrastructure to coordinate such a market place nationally.

The health care reform law assumed states would create and operate their own exchanges, setting aside billions in grants for that purpose.  Sixteen states have said they will not set up their own systems, and another five states said they want a federal-state partnership, while four others are considering partnerships.

States have different insurance markets and different eligibility requirements for Medicaid.  The Health and Human Services Department does not have the systems to effectively manage the nuances that exist state to state.  Since every state must have an exchange established by January 1, 2014, there is no time for the massive amount of work that lies ahead or the funding necessary for the implementation that will be larger than expected.

Experts have predicted that the department will soon have to tap budgets from its other programs to cover exchange costs.  Others have said it might charge fees on the insurance purchased in its exchanges once they are launched.

The idea behind the online exchanges is to match the uninsured with plans that meet their needs and reflect their eligibility for government help.  The process will require websites that can process massive amounts of personal information from users and yield search results for everyone.

Constructing these sites, which will need to be unique depending on the states individual insurance markets and eligibility for Medicaid, is just one task facing HHS when it comes to states that have decided not to do the job themselves.

While HHS has pushed back the cutoff points for states to choose how to run their markets, the department has indicated that the January 1, 2014, deadline is holding firm.


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DISCLAIMER: Because of the generality of this update, and based on particular situations, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice, financial advice and/or the advice of a licensed insurance or certified human resource professional.

© Connelly, Carlisle, Fields & Nichols 2012

Mick Constantinou

Author: Mick Constantinou

Mick Constantinou is Advisor at Connelly, Carlisle, Fields & Nichols (CCFN). In this role, he provides employee benefits for small- to mid-size groups, as well as individual insurance plans to the self-employed or people without coverage. Prior to joining CCFN, Mick was a Worksite Consultant for Liberty National Life Insurance Company in Tampa. His career background includes serving as a Communications Consultant for BOTH USA, LLC, and as a Training and Communications Director for Konica Minolta Business Solutions. Mick also held numerous director and managerial positions at Danka Office Imaging, and was Marketing Manager for Deloitte & Touche LLP in Tampa.
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