Twenty-three states, most led by Republican officials, have declared that they will not set up their own health insurance exchanges to help individuals and small businesses find affordable coverage. Instead, they want to offload that task to the federal government.
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In the short run it will not matter much who runs the exchanges. Consumers will be able to buy essentially the same policies and receive the same consumer protections either way. But in the long run, it would be best if states took on the job because they have the knowledge needed to mesh state and federal programs and encourage participation by local insurers and health care providers.
Under the Affordable Care Act, health insurance exchanges will serve as online marketplaces that will allow people to choose among insurance plans whose costs and benefits are easy to compare. The federal government will provide tax-credit subsidies to help pay premiums for people with incomes just above the levels allowed by Medicaid programs. The exchanges are supposed to be ready to enroll people by Oct. 1 for coverage that will start on Jan. 1, 2014.
Federal health officials announced last Thursday that 17 states and the District of Columbia are moving to set up their own exchanges. Seven other states have said they want to collaborate with the federal government to set up exchanges (states have until Feb. 15 to sign up for such partnership arrangements). A federal exchange will be available for all states that refuse to take any action.
The Affordable Care Act gives the Department of Health and Human Services responsibility for determining what "essential health benefits" must be provided by insurers and for designing Web sites for comparing plans, among other duties. The act also provides basic consumer protections, like the right to buy insurance without regard to health status, that apply both on and off the exchanges. Residents of states where political leaders seem bent on frustrating or sabotaging the health care reforms might well be better off with a federally run exchange.
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