The deadline has arrived for governors across the country to declare their intent to the U.S. Department of Health and Human Services on whether they will create their own state-run insurance exchanges under the new federal health care law.
Beginning in 2014, consumers and small businesses will be able to shop for insurance coverage on Internet-based exchanges or marketplaces.
President Barack Obama’s administration has said that states must decide by Friday, Nov. 16, though they have until Dec. 14 to submit blueprints for exchanges.
States actually have three choices: run their own exchanges, leave the task to the federal government, or set up a partnership dividing the responsibilities between state and federal governments.
In Tennessee, Gov. Bill Haslam has not yet made a decision but appears to be leaning toward deciding in favor of a state-run exchange despite many serious concerns. Approximately 250,000 Tennesseans would become eligible in 2014 to use the exchange to find affordable insurance, according to a University of Memphis study released in January.
“Tennessee has not expressed its intent on health care exchanges,” said David Smith, spokesman for Haslam. “The governor has said on the face of it he believes that states typically run programs more efficiently, effectively and at less cost than the federal government, but there are lots of unknowns and unanswered questions out of Washington at this time.”
Mike Chaney, Mississippi commissioner of insurance, submitted a letter Wednesday morning stating his state’s intent to set up its own state-run exchange system, but Gov. Phil Bryant has not made a final decision yet.
“There’s a good chance that exchanges will not succeed, but I would rather them fail at the state level than at the federal level. I do not want to give the future of the health insurance industry in the state of Mississippi to the federal government,” Chaney said. “If you default and kick the can to the federal government to operate the exchanges, you forever give up the ability of the states to regulate the insurance industry within your state, to regulate the products sold, to facilitate any consumer complaints and to prevent undue rate increases.”
In Tennessee, start-up costs for setting up a state-run exchange are estimated between $75 million and $90 million.
“My initial concerns about the Affordable Care Act have only been more fully realized when I see the impact that it’s going to have on our state budget, small businesses and providers,” said Haslam following the budget hearing for the Department of Health in Nashville earlier this week. “It is a complex decision and there are so many answers that we do not have yet.”
A state-run exchange would include some impacts on businesses, including tax deductions under a state exchange that would not be available in a federal exchange. The implantation of exchanges is also expected to create competition among private insurers and create more flexibility in determining eligibility.
“There’s going to be an exchange,” Haslam said. “Ultimately our citizens, through insurance companies, are going to pay for the cost of running that exchange. We think we can run it better and more efficiently ourselves. Our concern is how much flexibility will we have under a state-run exchange system?”
Haslam pointed to the state’s controlling of Medicare costs to 3.5 percent relative to the national average of 7 percent to 8 percent as evidence of better efficiency under a state-run plan.
Ultimately the Affordable Care Act is estimated to cost Tennessee $1.4 billion through 2019.
States that have elected to adopt a state-run exchange include California, Colorado, Connecticut, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Mississippi, Nevada, New York,
Oregon, Rhode Island, Utah, Vermont, Washington and West Virginia.
At least nine states will not be setting up their own exchanges, including Alaska, Florida, Louisiana, Maine, New Hampshire, South Carolina, South Dakota, Texas and Wisconsin. Missouri, Georgia and others are likely to join the list.
Arkansas is likely to seek a state-federal partnership to run its exchange.
Many Republican governors had held off on making the decision in hopes that Mitt Romney would win the recent election and carry out his vow to dismantle the Affordable Care Act.