As Congress plans the repeal of Obamacare, government websites set up to sell insurance under the program are beginning to grapple with an uncertain future and whether they can adapt to a GOP model down the road.
State-run exchanges in more than a dozen states cost billions to set up, and they serve as the public delivery system for Obamacare-compliant plans and federal subsidies that make coverage more affordable for low- and moderate-income Americans.
Yet, they’re also the “front-door” for determining whether customers qualify for the federal-state Medicaid program or tax credits on the individual market — a form of assistance that’s included in the Republican overhaul that squeaked through the House and is being reworked in the Senate.
Exchanges officials say they’re also positioned to market health savings accounts or other products.
“I think there’s still a possibility for us to look at new lines of business,” Connect for Health Colorado CEO Kevin Patterson said.
Already, Colorado is talking about transforming the exchange into a portal for county and state government employees who seek coverage through their public jobs.
The Health and Human Services Department awarded about $4.6 billion in grant funding to 16 states to set up their web-based exchanges, according to the House Energy and Commerce Committee.
Some of the portals fared better than others, however, and three states were forced to give up and shift online enrollment onto the federal website, HealthCare.gov.
Though the exchanges are intrinsically linked to President Obama’s overhaul, the House-passed plan to repeal and replace that law doesn’t touch them, giving exchanges officials hope they can still fill a niche.
“There’s nothing in [the bill] that repeals marketplaces,” said Mila Kofman, executive director of the D.C. exchange. “In fact, there’s language that talks about the new tax credits being advanceable. Generally, people who support this free-market philosophy also support full transparency and consumer decisions and consumer empowerment, and that’s what marketplaces are.”
However, the Trump administration is already trying to untether the insurance market from government portals.
The Trump administration said small businesses will no longer use HealthCare.gov to enroll employees who qualify for coverage through the SHOP program, and it’s paving the way for customers in dozens of states to seek out coverage on third-party sites without having to toggle back and forth between websites.
Robert Laszewski, a health policy consultant in Alexandria, Virginia, said while the exchanges could survive, they will play a diminished role as they compete for screen time with private players in the market.
“The Obamacare architects foresaw insurance exchanges doing away with agents and brokers thinking the exchanges would be a more efficient way to distribute health insurance,” he said. “Under the House bill that vision will be severely changed with exchanges becoming only one distribution vehicle and in direct competition with agents and brokers.”
Senate Republicans are trying to fast-track their replacement bill to a floor vote this summer, though they must clear sticking points in the policy and get a “score” from the Congressional Budget Office.
Senators drafting the plan are expected to make tax credits more generous for older and poorer customers who could be forced to pay more for their insurance under the House-passed template.
Michael Marchand, spokesman for the Washington state exchange, said it’s “kind of tough to hypothesize” how the GOP’s tax credits will be structured without a final bill, or if his state’s legislature will attempt to backfill any Obamacare-related benefits that are stripped out by Capitol Hill Republicans.
“If there’s a continuation of a tax credit at a federal level that needs to be implemented, we’re ideally suited to do that,” he said. “It’s just a matter of redefining how it works.”
The Nevada Health Link also said it needs to see a finished product before it plots its next moves, though “the exchange remains nimble and flexible and will continue to connect and educate Nevadans on how to access affordable care options.”
“It is likely that there will continue to be a need to certify qualified health plans, act as a liaison between brokers and navigators, service complaints and consumer issues, and educate consumers on their options under the [GOP bill],” Nevada Health Link spokeswoman Janel Davis said.
For now, officials at state-run exchanges say they’re focused on linking residents with coverage and tamping down confusion amid a shifting political climate.
Even if Mr. Trump signs a replacement into law, the GOP envisions two more rounds of open enrollment under Obamacare’s framework before major changes take effect in 2020.
The D.C. exchange posted a pop-up message on its website informing consumers that nothing has changed just yet, despite passage of the House GOP’s health bill.
“Morale here is very good and every day we fight to advocate for our customers,” Ms. Kofman said, though she’s concerned that the bill being debated on Capitol Hill will slash benefits too far.
“I worry about my customers potentially losing their tax credits, which is their lifeline,” she said. “It’s the only way they can afford health insurance.”
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