Contrary to expectations, the latest findings from healthcare researcher Decision Resources Group reveal that several of the state-based health insurance exchanges that were expected to perform the best are performing quite poorly, while some of the exchanges in Republican-dominated states openly hostile to the Affordable Care Act have fared surprisingly well to date.

Through February 1, Decision Resources reports that nearly 3.3 million people have enrolled in health insurance exchange policies nationwide, with the number exceeding 100,000 in eight states. Two of these are state-run exchanges in Democratic strongholds—California and New York—and were expected to succeed. But the other six—Florida, Georgia, Michigan, Pennsylvania, North Carolina and Texas—are federally-run exchanges in Republican dominated states where the expectations were much lower.

Most surprising, however, were the research group’s findings that, Maryland, Minnesota and Oregon—three Democratic-led states that invested heavily in their own state-run exchanges--were among the poorest performers.

Two other Democratic states with their own exchanges—Connecticut and Kentucky—performed exceedingly well and had very high levels of enrollment.

Decision Resources market analyst Bill Melville says a common factor among the states that have been meeting or exceeding expectations has been the relatively simplicity of their exchanges. "Keeping exchanges simple was a recipe for success, which led to some states receiving a higher evaluation in our analysis. State exchanges fraught with technical problems and enrollment struggles saw their rating plummet."

Decision Resources Group provides information and insights on various sectors of the healthcare industry. Last August it introduced a "State Exchange Report Card", which evaluates each state's exchange on a variety of criteria, including readiness, competition and potential to impact the state’s health insurance market.

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