Insurance exchanges open for business

October 1, 2013 in Medical Technology

Even amid the government shutdown, the new online insurance marketplaces — known as health insurance exchanges — were up and running today. There were early reports of computer glitches across several states. Some states, with large numbers of uninsured, are dealing with problems of a different sort.

In the states with largest uninsured populations, the stakes are high for this fall’s insurance exchange enrollment — the difference between the healthcare status-quo and improvements in healthcare access and sustainability.   

Some 5.7 million Texans, almost 25 percent of the population, are estimated to be uninsured, contributing to about $5.5 billion in uncompensated hospital care annually, according to the Texas Hospital Association. But with state leaders declining to expand Medicaid, a number of those uninsured may remain without coverage, caught in an eligibility “donut hole” — too rich for Medicaid but too poor for federal premium assistance, which starts at 133 percent of the federal poverty level under the Affordable Care Act.

Other states with large uninsured populations that are declining to expand Medicaid, like Florida, Georgia, Louisiana, South Carolina and Mississippi, may see similar disparities in access to health insurance for many low-income workers — unless they expand Medicaid, or craft agreements with federal health regulators to extend premium subsidies to residents earning below 133 percent of the federal poverty level.

In some of those states, though, there is still disagreement between government leaders over participating in ACA programs.

In Florida, where 3.5 million residents are uninsured, the deputy health secretary recently told the state’s 60 county health departments that ACA navigators hired by community groups under federal grants should not be permitted on county property. But county health commissioners in Broward County, in greater Fort Lauderdale, and Pinellas County, in greater St. Petersburg, voted to ignore the ban and allow navigators to work in county offices, while community groups, nonprofits and healthcare companies are trying to fill the gap in outreach for the federal insurance marketplace, amid public confusion with health reform.

Meanwhile, the Florida Agency for Healthcare Administration is asking the federal government for $3 billion in grants for the state’s low-income pool, for uncompensated hospital care.

In South Carolina, another state with Republican leaders opposed to Medicaid expansion, almost 500,000 residents are estimated to be eligible for subsidized insurance through the federal exchange, but still almost a quarter of a million residents could be left in the Medicaid-HIX eligibility gap. At the same time, the South Carolina Department of Health and Human Services is implementing a new reform strategy for healthcare delivery based on the Institute of Medicine’s Triple Aim goal.

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