National Press Club

State approaches to implementing Obamacare vary, officials say

March 8, 2013 | By Stephenie Overman | saoverman@gmail.com

Individual states are taking divergent paths to implement the Affordable Care Act (ACA) – i.e. Obamacare – a panel of state officials and outside experts reported at a National Press Club Newsmaker press conference March 8.

To comply with the act’s call for exchanges to serve as online marketplaces allowing people to easily compare insurance costs and benefits, 17 states have chosen to set up their own exchanges, the officials said.

In 26 other states, the federal government will run the exchanges, they said. States and the federal government will partner in seven more.

In New York, a state that is setting up its own exchange, “the preliminaries are up and running,” said New York State Sen. Neil Breslin. Breslin, a Democrat, formerly chaired the National Conference of Insurance Legislators’ (NCOIL) state/federal relations committee and is now the organization’s vice president.

On the other hand, North Dakota, “a strong Republican state,” was “not quick to accept” that the ACA would withstand constitutional challenges, said State Rep. George Keiser, a Republican and former NCOIL president.

“We waited, and the reality is we now have the Affordable Care Act. ... We’re trying to catch up,” Kaiser said. “North Dakota is in the federal exchange and we’re waiting for HHS [Department of Health and Human Services] to give us direction in how the federal exchange is going to be rolled out.”

The District of Columbia is building its exchange “from the ground up,” said Mila Kofman, executive director of the Washington D.C. Health Benefit Exchange. That means, Kofman explained, bringing together “diverse stakeholders” -- consumer and patient advocate groups, physicians, businesses, the D.C. Chamber of Commerce and faith-based communities.

“We are not going to be negotiating over rates,” Kofman said. “We want all health insurance companies to do business through us. …We want health insurance companies to offer as many products as they want.”

The D.C. exchange will require all health insurance companies and products to be displayed through its web portal, where people will be able to compare all products being sold. “We believe that transparency will result in better premium rates,” she said. “We believe that real market competition will drive down rates.” she said.

Jay Angoff, a Washington attorney who was the first director of the U.S. Office of Consumer Information and Insurance, said the exchanges called for by the ACA provide “an unprecedented opportunity to really drive down the costs of health care.”

If a competitive bidding process is established it “can force insurance companies to compete on price,” Angoff said. Otherwise, he warned, the exchanges may be nothing more than “a clearinghouse.”

“It’s a tremendous thing for consumers. But the technology required is huge,” he said.

Angoff said it’s not surprising to see that so many states have opted to be in the federal exchange even though states that run their own exchanges can benefit from HHS grants.

All insurance exchanges are supposed to be ready to enroll people by Oct. 1 for coverage that will start Jan. 1, 2014.