Among the health policy issues awaiting the outcome of the Nov. 6 presidential election is whether individual states will run their own health insurance exchanges. The deadline for states to deliver their "blueprint" plans for the exchanges is Nov. 16 so they can be ready to start accepting open enrollment in October 2013. If states don’t meet the deadline, the federal government will set up an exchange for them.[See also: ACA insurance coverage estimates updated following SCOTUS ruling]
Depending on if President Barack Obama is re-elected or former Massachusetts Gov. Mitt Romney wins election could signal a burst or lack of activity the final week before the deadline.
“I think there will be a lot of uncertainty about state responses if Mitt Romney wins, given that he has committed to repealing the entire law. I think those who are unenthusiastic about implementation will take that as a signal to not make any additional efforts until the question of the future of the law is resolved,” said Alan Weil, executive director of the National Academy for State Health Policy.
“In an Obama re-election, those who have been holding out and less enthusiastic, and those who have been even less enthusiastic about the government doing it for them, I think will ask themselves whether they think they can get ready in time because, at that point, I think the prospect of having a federal exchange will be very real and many will say that’s not where they want to end up,” Weil said.[See also: Insurance exchange establishment grants flow to 8 states]
The Department of Health & Human Services (HHS) provides states with significant flexibility as they work to implement the law and set up affordable insurance exchanges, according to a spokeswoman for the Centers for Medicare & Medicaid Services (CMS).
“Most states will take an active role operating their exchange, and we will work with any state to set up an exchange at any time. Consumers in all 50 states will have access to an exchange come January 2014,” she said in an email comment. She did not indicate the number of states that have detailed their plans.
Earlier in the month, Amanda Cowley, director of state health exchanges in CMS' Center for Consumer Information and Insurance Oversight, said that 14 governors had sent letters of their intent to establish an insurance exchange in their states.
“State-based exchanges, we believe, are the best models for states because of the flexibility they are given under the law,” she said at a conference sponsored by America’s Health Insurance Plans.
While Obama plans to put in place his signature health reform law, of which insurance exchanges are a critical part, Romney has pledged to repeal or stop in its tracks the Patient Protection and Affordable Care Act.
While Romney as president could slow the rollout of pieces of the health reform law, such as through waivers to states, repeal would require a vote of the Senate, which currently holds a slim Democratic majority. However, the Nov. 6 election could change that.
The most recent example of governors withholding pre-election action is that of New Jersey Gov. Chris Christie, who has stumped hard for Romney. State legislators this month approved a re-do of legislation he originally vetoed to authorize the creation of a health insurance exchange, but Christie has said that he will wait until after the election to decide if he should sign the legislation into law.
He explained that he has 45 days in which to sign or veto a bill, saying, “I won’t make a decision until I have to; I don’t have to make one until the 16th,” according to a report at New Jersey.com. Christie is up for re-election in 2013 if he chooses to run.
In Minnesota, Democratic Gov. Mark Dayton has moved to appease both sides. In a letter, he told state legislators that Minnesota could apply for conditional approval in November, “due to the great flexibility in the federal approval process,” and make further decisions when the legislature meets next year.
“While the Affordable Care Act continues to be debated in the political arena, the law is clear: Either we design and implement a state-based exchange, or we will be assigned to a one-size-fits-all federal exchange. Given this reality, we cannot afford to put exchange planning and development on hold,” he said.
“We can, however, wait to make final policy decisions until after the November elections,” Dayton said, adding that his administration would wait to make important policy decisions, such as exchange financing and its permanent governance structure, with the 2013 legislative session.
In the blueprint required by Nov. 16, states must provide details of their plans for a state-based or state/federal partnership exchange. Besides a letter of intent, the blueprint calls for an application to be filled out that will provide HHS with details of state plans.
States need to verify that they can perform certain required activities or the date when they anticipate being able to, such as those involved with eligibility and enrollment; qualified health plan certification, management and oversight; consumer outreach and education, Internet website, support from consumer navigators; small business health options program or SHOP, technology infrastructure and compliance with HHS IT guidance; and privacy and security standards, policies and procedures.
Some of the activities will need supporting documentation, and states and their vendors will come up with testing and validation programs as part of a standard systems development process.
In the event of a Romney election, Weil said that he anticipated that states that are committed to moving forward will continue to do so.“After all, a Romney election is not the same as a repeal of the Affordable Care Act, although it is his expressed desire to do so," Weil said. "Those states that have been moving forward are going to continue to move consistent with current federal law and will only change their course if there ultimately is a change in the law."