A break in the pattern

It's easy to become despondent when the news is this bleak.

Time is running short and the feds, as we've all heard, are struggling to launch the online health insurance exchanges – or marketplaces, as they're now called – by the Oct. 1 deadline.

"The administration right now is in a triage mode. Seriously, they do not have the resources to implement all of the provisions on time," Washington and Lee University professor Timothy Jost, a health care reform expert and advocate, told an oversight panel in the U.S. House of Representatives last week.

Jost was responding to news about the Obama administration's decision to postpone by a year the imposition of fines (yes, I know, technically, they're taxes) on large companies that fail to provide employees affordable health care coverage.

The more troubling delay was, in fact, announced earlier this year, when the administration decided it hold off on its push to give small employers a choice of insurance plans on the exchanges.

Remarkably, amid all of this summer's turmoil, there's a bit of good news to share.

According to a just-out Commonwealth Fund report, many of the state-run health insurance marketplaces plan to offer small-business employees a choice of health plans that won't be available in states with federally run exchange until 2015.

Better yet, many of the state-run exchanges are expected to provide consumers with a range of distinct plan choices exceeding the Patient Protection and Affordable Care Act's minimum requirements.

The report looked at the 17 states that, along with the District of Columbia, have elected to run their own exchanges.

Among the report's findings:

Nine states — California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, New York, Oregon and Rhode Island — plan to display data on quality in their marketplaces in 2014. That's a full two years before the federal government requires it.

Nearly every state-run Small Business Health Option marketplace will provide firms the ability to offer their employees a choice of more than one plan, starting in 2014. The federal government does not require this level of choice until 2015. In addition, eight of the states will let employers offer workers the choice of any plan in the SHOP marketplace.

Many of the states have taken steps beyond PPACA requirements to encourage a balance of healthy and sick people to enroll in the marketplaces, so that participating plans do not end up insuring mostly unhealthy people with high medical costs. California, for example, requires insurers that participate in the marketplace to offer the same coverage to consumers outside the marketplace.

While the law requires insurers offer health plans at a minimum at the silver and gold levels, eight of the states and the District of Columbia require insurers to sell plans at additional coverage levels.

Fourteen of the states and the District of Columbia used federal funds to adopt a one-stop-shop computer system that will be able to determine what kind of coverage potential enrollees are eligible for, whether marketplace coverage, Medicaid, or the Children's Health Insurance Program.

"The level of innovation many states have displayed in creating their health insurance marketplaces is an encouraging sign that states are working to ensure that consumers will be able to get affordable, comprehensive coverage in their state exchange," Commonwealth Fund President David Blumenthal said . "It will be critical for states to monitor their success and amend their design as needed to ensure consumers have the best possible experience."

So there you have it: finally, some sunnier news in a summer marked by way too many dark clouds.

For more from Allen Greenberg, see:

Ready, set, stop

Change PPACA's definition of full-time worker

Many HR managers remain confused by PPACA