Tuesday, November 20, 2012

HHS Steps up Role in Health Exchanges

While the Obama administration does not yet know the number states that will opt for the federal health insurance exchange option, the fact remains that it will be more than expected. Every state that decides not to implement their own exchange will be one more state that the federal government has responsibility for. As of now, only 17 states (and the District of Columbia) have signaled that they will set up their own system, leaving the federal Department of Health and Human Services (HHS) to step in and set up a system in the remaining 30 or so.

The main challenge in this role will be setting up a national IT infrastructure that can easily communicate with insurers and Medicaid programs throughout different states. Complicating matters is the fact that many of these systems are old and in the midst of an overhaul. The online systems will have to be operational in time for open enrollment in October of 2013, leaving only 11 months for upgrades, development, and implementation. These online systems, according to the health law, will allow people to enroll in different programs and find out about eligibility for subsidies or public assistance.

HHS stepping in also means that the states will be giving up some of the insurance oversight that they have traditionally had. Tasks such as plan certification, staffing call centers, and overseeing the operations would fall to HHS, at least in part, instead of the state counterparts. This could mean that plans, some of which have long-established relationships with state and local regulators, would find it more difficulty to navigate through the federal regulations.

With this short time frame, everyone is wondering if the exchanges will be ready in time to take effect. While no one knows for sure, most are optimistic the come January 1, 2014, the plans will be in effect.

View the article from Politico here

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