W.Va. lawmakers consider teaming with feds to set up PPACA exchange

Delegate Ricky Moye, a Raleigh County Democrat, was among several legislators who asked about those costs. Samples said recently announced federal rules allow for an exchange to charge participating insurance companies up to 3.5 percent of the premiums from policies sold within this marketplace. Insurers are expected to pass along those costs to policyholders, Samples said.

Several lawmakers also questioned whether other provisions of the federal overhaul hurt may hurt the exchanges.

One such provision bars insurers from charging older consumers more than three times the premiums paid by younger policyholders. Senate Minority Leader Mike Hall said that might discourage younger consumers from taking part in an exchange. Without younger, healthier people in the marketplace's pool, older consumers with multiple and often expensive health issue would drive up costs, the Putnam County Republican noted.

"Young people right now, a lot of them think they're bulletproof anyway, and they don't buy insurance," Hall said. "Obviously it's a problem that may be a very big problem."

Sample said insurance officials in West Virginia and other states are mindful of this possibility, known as adverse selection. He said other components of both the exchange provisions and the overall health care law are meant to give these marketplaces a fighting chance.

"The premium stabilization efforts are fairly monumental. Their importance can't be understated," Samples said. "(But) given that there's never really been anything attempted exactly like this on this scale, there is a great risk."