UnitedHealth Group Inc., the biggest U.S. health insurer, will face a fragmented regulatory landscape in 2014 under the first state insurance marketplaces approved as part of the health-care overhaul.
Rules for the six state insurance exchanges that won conditional approval from the Obama administration Dec. 10 are split evenly between those with strict criteria for companies that want to participate and states that have opened their exchanges to all comers, a scenario supported by the insurance industry. A high bar for inclusion could limit the number of insurers offering health plans in some states.
The exchanges, the heart of the 2010 Affordable Care Act’s plan to expand health care to 30 million people, have less than a year to open online platforms where local residents, with the help of federal tax credits, can shop online for insurance. The approved states are Connecticut, Maryland, Colorado, Oregon, Massachusetts and Washington, all led by Democratic governors.
“The challenge is it’s all new,” said Kim Holland, executive director for state affairs at the Blue Cross Blue Shield Association, a Washington-based trade group that represents 38 state insurance plans. “We have a really, really short period of time in order to get everything done.”
Enrollment in the exchanges must begin by Oct. 1 for plans that will take effect Jan. 1, 2014. The U.S. government plans to give states that run their own exchanges a share of about $2 billion to help get them started.
In Connecticut, regulators are taking a strict approach by making insurers meet requirements for patient access to doctors that exceed those of the federal Affordable Care Act. Insurers will have to make two-year commitments to participate in the Connecticut Health Insurance Exchange, and include almost all of the state’s U.S.-funded health clinics in their networks.
‘Passionate Role’
“The board saw its role as being very, I’d say, passionate about supporting consumers and trying to establish standards where health plans could reach to a slightly higher bar than required in the ACA,” said Kevin Counihan, chief executive officer of the Connecticut exchange.
At the same time, Maryland said it’s letting any plan that meets federal standards sell coverage at the start as the state rushes to craft a marketplace that will be popular with both consumers and insurers.
“What we’re focused on in the initial couple of years is really getting as many people enrolled on the exchange as possible,” Rebecca Pearce, executive director of the Maryland Health Benefit Exchange, said in a phone interview. “To do that we need to make sure we have as many carriers as possible.”