States have until June 1 to apply for federal permission to operate their own exchanges in time for the 2015 open enrollment season. And they must apply by the end of this year to be eligible for federal funding to build exchanges for 2016 or later.
It's possible several states such as Arkansas, Virginia and Illinois could apply for permission to move ahead in 2016, said Wade Horn, a director with Deloitte Consulting. "A lot of it depends on whether the politics line up."
Fueling speculation that Arkansas might take the leap was the hiring this month of Cheryl Smith, who worked as a consultant for Deloitte and for Leavitt Partners, by the Arkansas nonprofit board to explore the possibility of creating a state-run marketplace. Smith had run a small business exchange in Utah that predated the federal law.
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."
Wed, Apr 23 2014