States had to notify the federal government by Dec. 14, 2012, if they were going to build and run an exchange. They have until Feb. 15, 2013, to decide if they will run an exchange in partnership with the feds (with less flexibility in shaping the components of benefit plans offered), or default to a federally operated exchange.
As of late November 2012, 17 states and the District of Columbia decided to build their own exchange. Six states planned to partner, 17 states will let the federal government build and run the exchange, and 10 were undecided, according to the Kaiser report. Most of the states partnering or undecided have Republican governors, many of who have been critical of the reform law in general and of the costs in building an exchange, even if the feds are paying most of the tab.
“While not much is yet known about how the federal exchanges will operate, guidance released in May 2012 revealed some initial policy decisions,” according to the report. “The guidance indicates that federally facilitated exchanges will adopt a clearinghouse model and contract with any health plan that meets all certification standards as a Qualified Health Plan. The federal exchange will determine eligibility for individuals’ premium tax credit and cost-sharing reductions. In addition, the federal government will establish ‘Navigator’ programs with a role for agents and brokers to assist consumers in accessing health insurance.”
The Kaiser report, “Establishing Health Insurance Exchanges: An Overview of State Efforts,” is available here. The Department of Health and Human Services in recent days has begun to rebrand exchanges as “health insurance marketplaces.”