States consider merging exchanges: 5 things to know

Some of the 13 state-run healthcare insurance exchanges are considering becoming multi-state exchanges should the King v. Burwell ruling prevent Americans from getting subsidies on the federal exchange, according to The Hill.

Here are five things to know about the possible exchange mergers.

1. The multi-state exchange is still just an idea. While no states have acted yet, many are considering the option.It is possible we could see a California-Oregon or New York-Connecticut partnership, according to the report. Jim Wadleigh, CEO of Connecticut's exchange, told The Hill he has been in conversations with several states, especially in the past week, about possible partnerships.

2. The multi-state exchange idea is motivated in part by a predicted lack of funds. "What is happening is states are figuring out the money is running out," Mr. Wadleigh told The Hill. "At the end of 2016, everyone has to be self-sustaining." That is, if state-run exchanges cannot financially stand on their own, they will be required to join in 2016.

3. It is also motivated by the unknown outcome of King v. Burwell. "It's absolutely being driven by the court case," Joel Ario, former director of the federal government's Office of Health Insurance Exchanges, told The Hill. If the court rules against the government in the case, millions of people would lose subsidies on the federal exchange, motivating many of those states to join other states with their own exchanges, according to the report.

4. A shared marketplace is an option under the Patient Protection and Affordable Care Act. Delaware, Maryland and West Virginia commissioned a study to create a shared marketplace in 2013, but decided against the idea, which is considered to be what The Hill calls a "logistical nightmare." It would be difficult for states to fully share responsibilities in the marketplace, share costs and determine a governing structure, according to the report.

5. Sharing some services, but not all services, may be more feasible. If multiple states hire the same private contractor in a technology-sharing system, or share a regional call center or outreach team, it could help cut down on costs but save states from the logistics of a full-blown shared marketplace.


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