U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius today awarded a new round of Affordable Insurance Exchange Establishment Grants to Arkansas, Colorado, Kentucky, Massachusetts, Minnesota and the District of Columbia amid turbulent times in many states as they set up exchanges.
All but one of these states received Level One Exchange Establishment Grants—one-year grants awarded to states to build exchanges. The District of Columbia received a Level Two Exchange Establishment Grant—a multi-year grant awarded to states further along in building their exchanges.
Under the PPACA, health care exchanges are supposed to begin operating in 2014, with open enrollment beginning a year from Oct. 1, 2012.
However, many states that passed legislation early and are constantly working on the build out, like California—the first to pass legislation and has an exchange board established—still acknowledge exchange-building is a formidable task.
Meanwhile, feuds and confusion in other states, coupled with Republican skepticism over the Obama health act and state insurance regulatory energy to all, collide as governors figure out whether they should wait until after the general elections to roll up their sleeves on the exchange build outs.
For example, in today's grant-recipient Kentucky, Democratic legislators walked out of a debate last week when fellow committee Republicans tried to declare the governor's executive order establishing the health care exchange illegal, Kentucky Public Radio (KPR) reported.
The Kentucky GOP legislators said that the state legislature should be the one to have given approval to create the exchange, based on state law.
And in Minnesota, the Democratic insurance regulator there, Commerce Commissioner Mike Rothman, and Gov. Mark Dayton have been setting up an exchange without the legislature passing any exchange statute, ultimately resulting in an agent-commissioner feud that led to an about-switch in authority when Dayton removed the exchange's work product from Rothman and gave it to another state agency.
Late starts in decisions to go it alone or partner with the federal government in a federally facilitated exchange also mean that much work has yet to be done, with deadlines looming for all.
Agent and industry groups, like the National Association of Health Underwriters (NAHU), join some states in protesting that their work is further hampered by a lack of finalized rules from HHS on so many elements. They say it is unclear how to proceed in the design of products, in organizing workforces and the like.
Earlier this month Wyoming Republican Gov. Matt Mead announced in a press conference that his state would not be notifying HHS by the Nov. 16 exchange blueprint deadline of its plans for establishing an exchange because it could not decide on its exchange plan—the state lacked crucial information needed make a decision, according to a write-up by McKenna Long & Aldridge LLP and news outlets. Mead spoke about unanswered questions and said that he won't make any decisions on even how to proceed until after the state legislature adjourns in March, past critical deadlines, a Huffington Post piece reports.
Pennsylvania's Insurance Commissioner Michael Consedine struck much the same note in his criticism of HHS and its lack of clarity and its unanswered responses to questions during his Congressional testimony Sept. 12.
