The remaining state-based public health insurance exchanges can support themselves, for now.
Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), gave that assessment today during a hearing on the state-based exchanges, but he declined to talk about how sustainable the state-based exchanges will be in the future.
"I can't predict who's going to come into the federal exchange," Slavitt said, referring to state-based exchanges that decide to scrap their own enrollment systems and switch to HealthCare.gov, the exchange enrollment system set up by the U.S. Department of Health and Human Services (HHS). "As of today, all of the states are sustainable."
CMS is a division of the U.S. Department of Health and Human Services (HHS) and the parent of the Center for Consumer Information and Insurance Oversight (CCIIO), the agency directly responsible for overseeing the Patient Protection and Affordable Care Act (PPACA) exchange system, including the HealthCare.gov exchanges and the state-based exchanges.
The House Energy & Commerce oversight committee organized the hearing to look at how CMS is managing the state-based exchange program. HHS used PPACA grant money to help states set up exchanges, but the exchanges that went live in January 2014 were not supposed to use the startup grant money to cover operating expenses after Jan. 1, 2015.
See also: House runs three rooms of PPACA hearings
Slavitt said CMS has an effective program in place to review state-based exchange spending, reject use of HHS grant money for prohibited purposes, and recoup misspent money.
"We control the purse strings," Slavitt said.
Some lawmakers questioned whether CMS has done enough to punish states with failed efforts to set up exchange enrollment and administration programs.
Five states had serious information technology problems, Slavitt said. He said two of those recovered and are still running their own enrollment systems. Three have shifted to using HealthCare.gov.
CMS has already recovered money from one of those exchanges, is starting to recover money from a second, and is closing down and preparing to recover money from a third, Slavitt said.
Slavitt said most of the state-based exchanges use some kind of insurer assessment to pay for exchange operations, and that a few use general fund money to pay for exchange operations.
Rep. Susan Brooks, R-Ind., tried to get Slavitt to say how many exchanges have sustainability problems.
Slavitt told her CMS is talking to all of the state-based exchanges about sustainability.
"In some cases," he said, "there's a little bit of tough love."
In the past, CMS had tough conversations with managers of the Hawaii exchange that led to that exchange shifting to using HealthCare.gov, and it had conversations with the Rhode Island exchange that led to that exchange getting more revenue, Slavitt said.
