Different Takes: A Status Check On State-Based Exchanges

Even though the Supreme Court has not yet ruled on the legality of the health law, the overhaul continues to influence health policy in virtually every state — but in very different ways. One example: the creation of health exchanges. The mix of politics, state-versus-federal powers, and the size and type of resources have created a mash-up of implementation efforts that one state health policy expert described as uniquely “50-state-ish.”

Under the health law, these exchanges — which will be open for business in 2014 — offer the promise of one-stop-shopping marketplaces where millions of consumers and small businesses can go to buy affordable health coverage. They are one of the key mechanisms that facilitate the health overhaul’s coverage expansion. For states that choose not to operate an exchange, the federal government would step in.

Some states have stood firm against the law and refused to take any action. Others have followed a go-slow approach — waiting for the high court to send a clear signal. However, a handful have charged full-steam ahead, either moving the necessary authorizing legislation through state legislatures or by governors’ executive order.

Kaiser Health News recently checked in with three states actively pursuing a state-based exchange. Commentaries follow from Rhode Island, Utah and Maryland. A common theme emerged: No matter how the court rules, change is not going to stop.

Different Takes: A Status Check On State-Based Exchanges

Christopher F. Koller

Implementing The Federal Health Law In Rhode Island: More Than Insurance Access 
Christopher F. Koller, Rhode Island’s health insurance commissioner, said the health law provided “invaluable tools and blueprints for motivated states – like Rhode Island – to construct what works for their communities.” Through Governor Lincoln Chafee’s executive order, the state is moving aggressively to create a state-based health exchange. And, while state officials anxiously await the high court’s decision, Koller writes that Rhode Island “remains committed to reforming the health insurance market with this exchange no matter what the court rules.” Read the commentary


Different Takes: A Status Check On State-Based Exchanges

Patty Conner

Utah’s Health Exchange: Running, But Waiting For The Court’s Decision 
Utah, which is one of the states challenging the health law, established its health exchange in 2008. Patty Conner, the exchange director, offers a view of how this insurance marketplace has evolved and how it is confronted the challenges of integrating the existing system with the federal vision. But “ultimately,” she writes, “the success of the Utah Health Exchange… relies on the Supreme Court’s decision.” And, she adds, “if the law is overturned, states can continue to develop and run a state-based exchange, which is what Utah intends to do.” Read the commentary.

Different Takes: A Status Check On State-Based Exchanges

Lt. Gov. Anthony Brown

Establishing A World-Class Health Benefit Exchange In Maryland 
Maryland is among a limited number of states which approved legislation to create an exchange. This effort is part of broad set of state-based health care system reforms. Lt. Gov. Anthony G. Brown, who is coordinating these efforts, outlines Maryland’s commitment to reforms that he believes will lead to a healthier, more productive workforce; expand access to insurance; and help bend the curve of rising costs. He writes that the exchange is central to these efforts, and that the “exchange must be an open, transparent and competitive marketplace that’s easy to navigate, where consumers and small businesses can access federal subsidies or tax credits and find high-quality affordable health insurance.” Read the commentary.