Two Republican-led states are to some extent placing pragmatism over politics when it comes to the HIX marketplace, though their respective solutions veer off in different directions.

Idaho is the latest state to launch its own public exchange and only one of a dozen players pursing this approach whose state government is controlled by the GOP. With roughly 76,000 Idahoans signing up for 2014 coverage through, the Gem State became an early success story for the emerging online marketplace relative to other parts of the country. Idaho is one of 12 states, along with Washington, D.C., to run its own public HIX.

In the meantime, Florida has tweaked its Obamacare alternative to better meet the needs of prospective enrollees. The Florida Health Choice finally decided to sell ACA-compliant policies from four health insurance carriers, though federal subsidies will only be made available to residents who sign up through One strong motivation for this move was that just 49 people were said to have bought discount-only plans through FHC for 2014.

Also see: Big business backing ACA ahead of Supreme Court hearing

All governors, regardless of their political affiliation, “historically prefer to take things on themselves as states than yield to the federal government,” observes Trish Riley, executive director of the nonpartisan National Academy for State Health Policy.

So as such, GOP-led states that declined to follow Idaho’s lead embarked on a path that defies this thinking. “But it may also be that some governors didn’t want to take on that federal spending that would support the exchange,” she explains.  “There’s no question that running a state exchange is a very significant commitment with lots of data and management requirements.” Her sense is that these states also concluded that the Affordable Care Act didn’t given them the flexibility they wanted.

It makes sense for Idaho to go this route, since “it’s easier to build a manageable system” that serves a much smaller-scale population than larger states, opines John Sarich, vice president of strategy at VUE Software, an insurance automation company.

Also see: Colorado exchange faces expanded audit, dodges bullet

The experience could prove to be more consumer-friendly. Robert Booz, a health care analyst with technology consultant Gartner, says Idaho requires that enrollees “enter lots of what I would call registry information, including things like Social Security number, and there is a tie with registry information to price.

“However,” he continues, “potential members also need to know what their product choices are simultaneous to or before they identify price. So the faster, fewer keystrokes that you can get product information out in front of the product decision-maker, the better.”

Idaho’s Republican governor, C.L. “Butch” Otter, and business leaders had persuaded the legislature to use $35 million in federal funding to build a state exchange to better control costs and help 165,000 residents buy coverage. The state decided on a lower HIX surcharge for insurers to cover overhead costs compared to (1.5% on premiums vs. 3.5%), hoping it would translate into lower prices for consumers.

Also see: The 10 U.S. counties with the lowest enrollment rates

Idaho’s health insurance costs are among the nation’s lowest, though its uninsured rate usually is above the national average, according to Kaiser Health News. One related challenge is it’s among 23 states that declined to expand Medicaid under the ACA.

FHC initially offered monthly discount cards of $6 to $25 for telemedicine, dental, vision, prescription and chiropractic care. The plans couldn’t be marketed using the words insurance, coverage, benefits or premiums. Critics and proponents of the venture had squared off on the subject of launch delays, which saw a retooling of the FHC website to accommodate public interest that was reported to be 10 times higher than anticipated.

Florida’s 2014 enrollment was the highest among states that steered their residents to at 983,775. More than 1 million Floridians are expected to sign up for health insurance from 14 carriers in 2015, nearly a quarter of whom will be first-time enrollees. More than 90% of Florida residents who signed up for 2014 coverage through the federal exchange qualified for financial assistance. The state’s uninsured rate has been among the nation’s highest during the past two years.

Also see: The 10 U.S. counties with the highest enrollment rates

What’s significant about FHC is that it builds on Florida’s long history of creating purchasing pools, according to Riley. “They were the first state that 10 to 20 years ago began to pool employers and individuals to find new ways to purchase insurance,” she says.

Bruce Shutan is a Los Angeles-based freelance writer.

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