Arkansas is one of seven states this year that have a federal partnership marketplace, meaning it handled tasks such as certifying health plans and providing consumer assistance. The others are Iowa, Illinois, Michigan, West Virginia, New Hampshire and Delaware.
Although some state exchanges, including those in California, Kentucky and Washington, exceeded expectations, technical problems with others hampered enrollment.
"We have been a little surprised by some of states that have done their own exchange and encountered great difficulties … and that will dissuade some other states from taking it on themselves," said Ceci Connolly, managing director of PwC’s Health Research Institute.
She said a dominant federal exchange could be better for consumers and health plans. "Insurance is complicated enough, so some uniformity is helpful to consumers in making choices and helpful to plans selling in the marketplaces," she said.
While the federal health insurance exchange overcame its initial stumbles, enrollment varied across the country just like in the state-run exchanges. Florida far outpaced Texas in enrollment, even though both states relied on the federal marketplace.
"At the end of open enrollment in 2014, there was a better rate of success for healthcare.gov than state exchanges," said Caroline Pearson, a vice president at consulting firm Avalere Health. "Generally, having states stick with something that’s working well enables consistency across the country and efficiency."
The Obama administration is expected to make some small changes to the federal exchange, such as giving users a direct link to insurer's provider network directories, Pearson said.
Horn of Deloitte said total enrollment should not be the only factor used to measure the success of exchanges. He said state-run exchanges have more control over the interplay with their Medicaid program so consumers can more easily move back and forth between that program and private plans purchased on the exchange. The federal exchange was unable to transmit the information from tens of thousands of people deemed eligible for Medicaid from its computer to state Medicaid programs.
And some states hope to score political points by having a state-run exchange.
"Creating our own unique technology platform will continue to prevent federal intervention and gets Idaho closer to its goal of being a completely self-sustaining exchange," said Stephen Weeg, chairman of the Idaho exchange board.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
Wed, Apr 23 2014