Amid mounting concerns about cost, some states are mulling whether to merge their health care exchanges, according to an analysis in The Hill last week.
States are feeling two major stressers, according to the report: Federal subsidies for the exchanges are slated to run out next year. And currently, the Supreme Court is considering a case to determine whether the federal health exchange can offer subsides the way exchanges set up by state governments do.
Several experts, like Jim Wadleigh, the director of Connecticut’s successful health exchange, said some of these factors are pushing states to get more creative about how they’re handling their exchanges.
“At the end of 2016, everyone has to be self-sustaining,” Wadleigh said. “In the last seven business days, I’ve probably had seven to 10 states contact me about contingency plans.” Though, he declined to name which states contacted him.
Already, some states are working together to stand up exchanges. Indeed, Connecticut shared code with Maryland, whose own exchange failed to launch.
According to some experts, though, the creation of a multistate marketplace could be a logistical nightmare. Jennifer Tolbert, a state health expert at the Kaiser Family Foundation, said “one of the trickiest issues,” would be establishing a governing structure for the multistate exchanges. In fact, Delaware, Maryland and West Virginia commissioned a study on the strategy in June 2013, but the states have since abandoned the idea.
A technology-sharing system could be feasible though, Pat Kelly, the director of Idaho’s health exchange, said. In this scenario, participating states would hire the same private contractor and create a regional call center or outreach team. But even though some form of collaboration is possible, that doesn’t mean it’s coming anytime soon.
“There’s a lot of states that are trying to crack this sustainability problem, and there have been times when they’ve talked about regional solutions, but it’s really been very early on in those discussions,” Kelly said. “Is it possible and is it a good idea? Absolutely. Every time you can share the costs, it’s going to be more efficient.”