Maryland has firmly established its health benefit exchange under the Affordable Care Act and has a long-term plan in place. But 40 states, including Virginia, have not passed legislation authorizing health benefit exchanges in their borders as required by the law.
States have one more week to present a state-facilitated exchange blueprint before the Dec. 14 federal deadline. States also have the option to default to a federally run program or create a state-federal partnership.
The exchange is designed to allow Marylanders to compare rates, benefits and quality among plans to help individuals and small employers find an insurance product that best suits their needs.
In a panel Thursday at the Washington meeting of the National Conference of State Legislatures, Virginia’s Secretary of Health and Human Services agreed with many other state legislators in attendance that Virginia is divided about creating an exchange. Unlike Maryland’s embrace of the Affordable Care Act, Virginia was one of two dozen states that sued to block it.
“I don’t think we can build a state-based exchange, so on December the 14th we will say we can’t do that,” Bill Hazel said. “I believe that through June of last year we were probably as far along as any state in our preparations to build an exchange. Right now, due to the uncertainty and the unknowns, we made a decision that we were going to sit and wait for questions to be answered.”
Maryland is a national model for the implementation of an exchange program. It has passed two laws in the past two years that have established its exchange as a public corporation and an independent unit of state government. The state has also received four federal grants for the exchange, including one for $123 million in August.
Maryland is one of six states, along with Washington, D.C., to have received Level Two Establishment grant funding, which fund planning and implementation in the first year of operation. They were approved in August.
In order to receive the Level Two grant, states must show that their exchanges have legal authority. Maryland’s exchange has had this power since 2011, when it passed the Maryland Health Benefit Exchange Act of 2011 which also created the exchange’s board of trustees.
On the NCSL panel, Maryland Health Benefit Exchange Policy Director Frank Kolb said in creating an exchange, it is imperative to create an open and transparent process in which stakeholder interests are taken into consideration. That is something he said Maryland has been doing long before he took the position of the exchange’s policy director.
“When I was doing the research about the opportunity [to work in Maryland], I was just impressed with how far along Maryland was just in general,” Kolb said. “They had already been through a year and a half of public hearings with advocates and industry folk along the way.”
Kolb said another big reason why Maryland is ahead of other states with its exchange is due to the early action by state leaders.
“I think that the fact that we were able to have such good guidance coming straight out with the legislators and the governor’s office,” Kolb said. “I think a lot of it was willingness to open the doors early.”