Think about it: At this point in the rollout of the Affordable Care Act, there are 36 states relying on the federal infrastructure of Healthcare.gov a site created by the U.S. Centers for Medicare and Medicaid Services once it became evident that many Republican-leaning states would not be creating their own state-run exchange infrastructure to comply with the health law. That leaves 15 states including the District of Columbia currently operating autonomously from the federally facilitated marketplace.
A recent article by POLITICO postulated whether this setup might turn into a national health insurance exchange, even by default, as two more states have opted into Healthcare.gov recently and even more state exchanges could fall apart given the stipulation that they cultivate their own funding and operate without federal monies in coming years.
Brokers and agents who are enrolling consumers on public exchanges across the country say they dont think much will change from the way things are currently structured, despite favoring a more local approach.
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State control over an insurance market is almost always better than widespread federal control, says Liz Gallops, broker at Allegacy Insurance Solutions in Winston-Salmen N.C., and vice president of North Carolinas National Association of Health Underwriters chapter. From a brokers perspective, state-based control would mean the brokers feedback is likely to hold more weight. We would likely have more support in the process and be able to more quickly solve consumer and enrollment issues.
Ronnell Nolan, president and CEO of Health Agents for America Inc., agrees that most brokers and insurance industry insiders probably prefer a state-focused approach. Without our states to fight for us, I am worried the federal government will continue to erase the agent community from the market, she says, referring to difficulties brokers and agents had in federally facilitated marketplaces getting trained, questions answered and credit for the applications they assisted with.
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Gallops says she doesnt foresee every single state opting into Healthcare.gov since large and experienced states like California and New York have done well managing their own. But, over time, it may become even more lop-sided than it is now with the majority of states on the national exchange.
Its also important to think about what a national exchange would really mean. Right now, while the federally facilitated marketplaces have the same backend infrastructure and are staffed by CMS workers at the Maryland-based agency, the insurers available on each exchange are localized by state. A truly national exchange with similar insurers across a majority of states would be the most detrimental to the insurance industry overall, says Anne Petry, insurance broker and consultant at Jaggi Insurance and Investments in Forsyth, Ill.
A national exchange could force those [regional companies that have regional networks] out of business as they cant provide the national network most people will think they have when they purchase a plan on that exchange, she says about the hypothetical broad marketplace.
History
Michael Keegan, who has worked as a lobbyist for several agent-focused trade groups throughout the past several years, says that before the passage of the ACA agents were very against state-based exchanges. Agents hated the Massachusetts law, and I used to lobby against every state exchange proposal prior to 2010, he says.
At first, the ACA was intended to create 51, including D.C., state-based exchanges. There was an assumption in certain states that not participating in the exchange meant not having to comply, or that establishing an exchange was somehow akin to endorsing the ACA, Keegan continues.
Quickly, however, agent/broker trade organizations almost universally supported state-based exchanges given the traditional state regulatory role over insurance generally and producers specifically, but also for the pragmatic reason that state exchanges would be more sensitive to the concerns of agents than a federal agency with little practical experience in insurance regulation, he adds.
