Government Research Reports

State Health Insurance Exchange Market, 2013 (Mar 2013)

While more than $3.5 billion in health insurance exchange (HIX) funding has been awarded to states, vendors must remain nimble and aware of the politics of Obamacare.

Description

Prior to the 2012 election, all but two states took federal grant money to plan an HIX. However, the re-election of President Obama has opened a whole new round of political wrangling over state-based implementation of the Patient Protection and Affordable Care Act (PPACA) of 2010 (a.k.a. “Obamacare”). This report is the first to detail the emerging implementation models that will carry states to the 2014 go-live date for all types of health insurance exchanges (HIXs).

This report examines the following components of the national HIX market:

• State-based exchanges that must be financially self-sustaining by January 1, 2015
• State-federal partnerships that provide a framework for tailoring aspects of the federal exchange to state markets
• The federal “Health Insurance Exchange360” that will serve states that opt-out of the previous two options

At this point fewer than half of the states are implementing an HIX of their own or in partnership with the federal government. However, implementing states will be creating platforms that non-participating states might adopt down the road if implementing states deliver superior results. The current environment means vendors must look beyond HIXs to find state-based health care reform efforts. With more than 200 HIX-related opportunities identified across 49 states, even those states that have opted out of implementing their own HIX will still be consuming a variety of technologies and professional services in efforts to reduce health care costs for Medicaid/SCHIP recipients and other citizens.

For the time being, HIXs should be seen as a leading indicator of state-based health care reform efforts, but not as the only indicator of such efforts. This field of state activity will remain dynamic between now and the end of the Obama administration in 2016.

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