States must provide details to the federal government by Nov. 16 — just 10 days after the presidential election — on how they will run online insurance marketplaces, according to guidance released Wednesday.
Those that don’t meet the deadline – or that can’t operate their own marketplaces, called exchanges – will have it done for them by the federal government, starting in January 2014.
The marketplaces, which are mandated by the 2010 health law, are designed to increase competition among insurers and to make coverage more affordable. States can choose to run the exchanges, elect to perform only some services or cede control to the federal government, officials said Wednesday. The Department of Health & Human Services “will seek to harmonize … policies with existing state programs and laws wherever possible,” according to a separate report offering a few details on what a federal exchange might look like.
While the guidance does not indicate whether there will be a governing board overseeing the federal exchanges, it does say the federally-overseen marketplaces will accept any insurer that meets the basic requirements.
Some consumer groups, including the American Cancer Society Cancer Action Network wanted the federal government to be more selective, in hopes that it would drive insurers to compete harder on pricing and quality measures.
But Steve Larsen, the federal official overseeing the federal exchange effort, said the initial approach would be an open marketplace, but he told reporters that in future years other options may be explored. States that run their own exchanges are free to choose whichever model they prefer.
While many states are moving forward – 34 have received federal grants to pay for planning efforts – others are moving slowly or not at all. Six states — Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington — received additional grants on Wednesday totaling more than $181 million.
According to news reports, officials in some state say they are holding back pending the Supreme Court’s decision on the constitutionality of the health law, expected at the end of June. The court could uphold the entire law, strike it down entirely or eliminate some parts of it.
Other state lawmakers have said they want to hold off on creating the marketplaces until after the results of the November election are known. Larsen reiterated the government’s stance that the court will uphold the law and that the president will be re-elected, and he said “states should turn their attention to moving forward.”