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The White House does give states some flexibility in setting standards for their marketplaces. They get to decide who runs the new market and which insurance companies get to participate. They can outsource some functions that they don’t have capabilities for to the federal government.
At the end of the day though, it’s the White House that will determine if a state’s health insurance exchange is up to snuff. The new marketplaces will launch on Jan. 1, 2014. But a year prior, in 2013, Health and Human Services will certify which exchanges are - and aren’t - able to deliver the customer experience that the White House wants to see. That includes things like allowing consumers to easily compare plans and having an enrollment mechanism for both private insurance and Medicaid. States will have to summarize these developments next year in what the administration has now dubbed an “Exchange blueprint” before getting the go-ahead.
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“The regulations issued today by the Department of Health and Human Services extend the federal government’s reach into the states and will cost the states millions of dollars annually to operate,” Republican Governors Association president Bob McDonnell, Virginia’s governor, said in a statement.
But, for the Obama administration, there’s a strong interest in ensuring that the health reform law looks a lot like what the law envisions: These exchanges are the main tool for expanding insurance to millions of Americans. So in walking a tightrope between stringent standards and state flexibility, the administration has leaned slightly towards the former.
http://www.washingtonpost.com/blogs/ezra-klein/post/building-a-better-health-insurance-exchange/2012/03/12/gIQA3tez7R_blog.html
Hat Tip: Washington Post, Wonkblog, Sarah Kliff
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