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Health Law Markets' Financial Viability on Feds' Radar

By Rebecca Adams, CQ Roll Call

May 11, 2015 -- The Centers for Medicare and Medicaid Services will host state-based health law marketplace officials this summer in a conference to talk about the exchanges' financial viability, federal marketplace CEO Kevin Counihan recently said.

This is the first year in which state-run marketplaces must be financially independent, and several are struggling. A number of states use taxes on health insurance as a major revenue source, but health insurance industry officials are pushing back against increases.

Counihan said in remarks at the Health Insurance Exchange Summit in Washington that the upcoming conference will be one way that CMS officials will enhance communications with state-based exchange officials, with whom federal officials have regularly-scheduled calls twice a month.

"We've got good practical leadership there," Counihan said of state officials. But each exchange operates in a way that mirrors individual businesses, he said.

"Our role is to do everything we can to account for those differences and help those folks succeed," he said.

Counihan wouldn't comment on whether some state-run marketplaces might find the challenges so difficult that they could hand over part of their operations to the federal marketplace.

When asked if some states that currently rely on might want to switch to become a state-based marketplace, Counihan said the time it would take to make a conversion would depend on how much of the operations a state wanted to assume responsibility for overseeing.

Counihan said that if any wanted to fully transition all of the operations to state officials, it would be "a very, very complex activity."

"It takes a period of time," he said. "It's not something folks could do for this open enrollment" this fall.

The Supreme Court is expected to rule by the end of next month on a case about whether federal insurance subsidies should be allowed in both the federal exchange and state-run marketplaces or only in state-run marketplaces. Some policymakers are watching to see whether some states would try to change their status to state-run marketplaces if the court were to strike down federal subsidies in states that rely on the federal website for enrollment. Counihan declined to comment on the case, King v. Burwell.

CMS officials are in the process of collecting enrollment counts from state-run marketplaces, Counihan said, and will soon be releasing an updated report of how many people are enrolled in federal and state exchanges.

Next year, the federal exchange will be "better and faster" than this year because the administration in working on continued enhancements to the site, both in ways that consumers see and in back-end processes that are invisible to consumers but that affect business processes used by health insurers and others.

Counihan suggested that federal officials are trying to make it easier for consumers to get information by, for instance, making it simpler for patients to type in their primary care provider to see which health plans have the doctor in their networks or plug in the name of a drug they are taking to quickly compare which plans cover the medication.

Counihan also said CMS officials will meet with web brokers soon to discuss plans for next year.

And he said the agency is working collaboratively with insurers to ensure that consumers will get updated information in more granular detail about which providers are in each plan's network, so that a patient going into an emergency room won't have to worry that although the hospital is in the network, some medical providers may not be.

"We see that as part of our role," he said, adding, "We recognize that as someone's being pulled into an ER, they're not going to have a provider directory with them."

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