Connecticut’s AccessHealthCT is poised to become the nation’s first state-run marketplace that will be financially self-sustaining in 2016 when federal grants end for these online marketplaces as stipulated under the Affordable Care Act.

The reason is twofold, explains AccessHealthCT CEO Jim Wadleigh: Connecticut was the first state to pass a fiscal 2016 budget and “no other state has an assessment or plan that makes them self-reliant.”

Also see: Senators question CMS over state-based marketplace reimbursements

Moreover, Wadleigh says it’s the only state with reserves, which are running about 50% of the exchange’s operating budget. Within two years, the goal is for those reserves to reach 75% to 100% of the operating budget.

AccessHealthCT’s assessment levied on insurance plan premiums to cover daily operations, which generated about $26 million a year, was 1.35%, or basis points, for the first two years on all individual plans sold on and off the exchange, as well as small-business plans that met the 50 and under limit.

It was raised to 1.65%, representing about a 15% increase, “for the sole purpose of increasing our reserves for the organization over the next two years,” Wadleigh reports. The modest increase is expected to add only about six cents a day for each enrollee.

He says AccessHealthCT’s budget includes between $18 million and $20 million a year for daily operational expenses and another $7 million to $8 million to invest in infrastructure, technology, marketing or other areas.

Also see: Consumers in state-based marketplaces said, ‘I better shop around’

The nation’s 15 state-run public exchanges, including the District of Columbia, have different sustainability plans, according to Trish Riley, executive director of the nonpartisan National Academy for State Health Policy.

“California is in great shape,” she observes. “Colorado is tapping into some of the funding from its former high-risk pool. New York has state appropriations. Massachusetts is partially using state appropriations. Rhode Island just had legislation passed to get its appropriation in place.”

Others are “redesigning and restructuring,” she adds, noting how New Mexico is negotiating with the federal government about leasing its IT platform.

What makes Connecticut particularly unique or noteworthy is an effort under way to offer consulting services to other states, Riley notes. “They’re really thinking long-term,” she says.

Maryland is using the Access Health Exchange Solutions platform, which AccessHealthCT hopes will raise $3 million next fiscal year, to run its exchange and other states are also in discussions about sharing services or leveraging contracts, according to one report. Wadleigh recently met with the heads of all state-based marketplaces in Washington, D.C., to plan for the upcoming enrollment season.

Although AccessHealthCT is technically a quasi-state agency, the goal is to run it like a business, says Wadleigh, the exchange’s former CIO who last summer succeeded Kevin Counihan when he became the first CEO of Healthcare.gov. “We all came from the private sector, and we try to bring the private sector view into it,” he explains.

He describes his predecessor, as an industry expert on public exchanges who casts “a very big leadership shadow. As much as I say I want to get out from underneath it, we’ve got a very good friendship, and since I’ve been working with him, he’s been a tremendous mentor, and I really do look up to him and his expertise.”

Wadleigh says he’s “humbled by the position that our governor, lieutenant governor, board and legislature has put me in to be able to be perceived as leading the country when it comes to a lot of these things.”

In related news, the Connecticut Insurance Department recently held public hearings to weigh proposed rate increases for 2016 by Anthem Blue Cross and Blue Shield, which is seeking an average increase of 4.9%, ConnectiCare, which is seeking a 9.8% increase, and Golden Rule Insurance Company, which is seeking an 18.5% increase.

 

                                       

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