States join to create tools for implementing Affordable Care Act
By Sarah Kliff,
For 14 months, a bipartisan group of 17 states has been quietly collaborating with the Obama administration to help build a foundation for the health-care reform law’s success.
The group includes some of the law’s staunchest supporters working alongside a handful of its bigger detractors. They are backed by $3 million in funding from eight nonprofit organizations that hope to see the Affordable Care Act succeed.
Together, they have come up with a tool to help consumers navigate the health insurance exchanges — the marketplaces that each state is required to have by 2014. The tool will be released Friday for other states to use if they wish.
The project’s nonprofit backers hope it will give all states one of the resources they will need to hit the health-care law’s tight deadlines and provide assistance to states that have run into financial and political obstacles moving forward.
“There’s no reason to leave this very important subject up to political vagaries and budget shortfalls,” says Mark Smith, president of the California Healthcare Foundation, which organized the effort.
Many health policy experts consider the health insurance exchanges, where most of the 32 million Americans expected to gain coverage will compare and purchase health insurance, to be the backbone of the Affordable Care Act.
The exchanges also have become a battleground in the fight over President Obama’s signature legislative achievement. Each state must have a marketplace in which consumers can compare coverage, learn whether they qualify for subsidies and ultimately purchase a plan. If a state does not have a framework in place by 2013, the Department of Health and Human Services will come in and do the job itself.
Many Republican-governed states have slowed or halted work on implementing a health insurance exchange, saying that it is prudent to wait until the Supreme Court rules on the law’s constitutionality. That decision is expected by the end of June.
But many officials acknowledge that if the law is upheld, their states will want to run their own exchanges. This collaborative is more evidence that states across the political spectrum are still planning to meet the health overhaul’s deadlines.
“There is no work being done to build an exchange in Kansas at this point,” says Linda Shepphard, director of the Kansas Insurance Department’s accident and health division. “We have certainly discussed internally, though, that if the law stands there may be a point at which the governor might decide he would want to have an independent Kansas exchange. If that were true, we want to have all the tools available to us.”
The California Healthcare Foundation thought up the idea of working with states on health insurance exchanges in early 2011. Eleven states initially participated; that number grew to 17 as work got underway and the word got out. The collaborative, officially Enroll UX2014, includes New York and Washington, which have embraced the Affordable Care Act, and Republican-governed states such as Kansas, New Mexico, Alabama and Tennessee.
The states worked with the design firm Ideo to come up with a consumer interface that determines how many options consumers should see at one time, for example, and the order in which those options should be presented.
There is still much work for the states to do — to build, for example, technology that can verify an individual’s income and calculate any available subsidies. But they say that outsourcing the consumer interface component may have saved “months” of work.
“It saves our staff a ton of time not having to come up with this in advance,” said Richard Fiore, executive director of the Alabama Health Insurance Exchange.
Alabama is one of the 26 states challenging the health reform law. Even so, Fiore says that it’s his job to prepare the state for the possible need for an insurance exchange.
“We do know where the deadlines are as the law currently stands,” he said. “And we do know that, by being part of this project, that we’re working towards meeting them.”