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Health Insurance Exchange: State versus Federal
According to Goldstein (2018), ever since the ACA has been in effect, states with their own healthcare exchanges have fared significantly better than those who simply rely upon the federal exchange. States have greater flexibility in advertising directly to potential enrollees and can extend the signup period. The local flexibility also means that consumers can receive more personalized help, given that state exchanges are only responsible for informing a smaller pool of individuals about the confusing process of signing up and selecting insurance (Goldstein, 2018). On the other hand, it is also important to be realistic about the extent of a state exchange to fundamentally help consumers. State exchanges cannot ignore federal requirements that insurance policies must meet certain stipulated standards and have mandatory enrollment, regardless of consumers’ preexisting conditions.
As a result, premiums are expected to go up, regardless, and there are fears that the limited choice available on the exchanges will mean that some consumers will elect to go without insurance, regardless of the penalty they must pay, versus pay for prohibitively high-cost coverage (Archambault, 2013). But given that premiums are likely to increase, that is all the more reason to accept the Medicaid expansion for the state. More people, including the middle-class, will need support to pay what can be prohibitive monthly costs.
As a result, the state needs to step in, even if it proves to be expensive. Consumers are likely to blame the leadership if they see prices increase and they are not given assistance. Also, this may mean families become reliant upon other sources of financial aid, if they are not able to pay their premiums. Even if the state is making due with fewer resources, reaching out to healthcare providers and nonprofits within the industry may be useful. These stakeholders can help provide assistance in advising the state how to set up the exchange and engage in outreach efforts to community members throughout the sign-in process.
References
Archambault, J. (2013). Do premiums differ in states with a state-based exchange versus federal exchange under Obamacare? Forbes. Retrieved from: https://www.forbes.com/sites/theapothecary/2013/11/12/do-premiums-differ-in-states- with-a-state-based-exchange-versus-federal-exchange-under-obamacare/#497a457059d8
Goldstein, A. (2018). ACA’s state-run insurance exchanges fare better than the law’s federal marketplace. The Washington Post. Retrieved from:
https://www.washingtonpost.com/national/health-science/acas-state-run-insurance- exchanges-fare-better-than-the-laws-national-marketplace/2018/02/07/7a0d73b6-0b77- 11e8-8890-372e2047c935_story.html?utm_term=.a6a78877de4e
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