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Exchange Tally Complete

Tally marksThe “roll call” on Health Insurance Exchange decisions from each state has come and passed on December 14. Each state has the option of operating their own exchange or ‘partnering’ with the federal government to run an exchange. Should the state decide to do neither, they default to a federally-facilitated exchange. Regardless of the decision, the exchange must be ready to cover qualified individuals and small employers by January 1, 2014.

Iowa made the decision to pursue the “Partnership” Exchange, which is a ‘hybrid’ between a Federal Exchange and a State-based Exchange. Given the deadline to make this decision, it was Iowa’s best option for the time being. The Cliff Note version of the Partnership Exchange is that states can choose to:

  • Operate certain plan management functions
  • Operate certain consumer assistance functions
  • Conduct Medicaid and Children’s Health Insurance Program (CHIP) eligibility determinations (or have the Federal Government perform this)

The Department of Health and Human Services (HHS) will perform any remaining exchange functions in order to meet the standards established by the Affordable Care Act (ACA). With its’ decision, Iowa must submit a blueprint to HHS by February 15, 2013. HHS will then issue approvals beginning in March, 2013.

Establishing its’ own exchange takes considerable time and analysis for any state, Iowa included. The Partnership Exchange appears to be a viable solution that will allow Iowa to eventually pursue its’ own exchange – perhaps as early as January 1, 2015. Until then, heavy lifting will be necessary to assure that stakeholders are heard, insurance markets are carefully analyzed, and most importantly, Iowans are best served.

So what is the final tally* of the decisions made by states regarding exchanges for 2014?

  • Partnership Exchange (7 states)
  • Federal Exchange (25 states)
  • State-Based Exchange (18 states and the District of Columbia)

The next year promises to be a very tumultuous period for Iowans regarding health care and health insurance. Iowa employers will need to spend considerable time and energy learning about the changing insurance world that will impact their business. It will not be an easy task.

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*The Henry Kaiser Family Foundation


  1. Anne Kinzel says

    I have to say that Iowa has really chosen the path of least resistance. this was done under the guise that this was because the state was under some sort of time constraint in which to ale a difficult decision.

    With all due respect to my good friend David Lind, I have to say this time-crunch has been entirely manufactured by the Branstad administration for its own potential political gain. The governors in states who are determined to serve their constituents health care access needs have been aggressively pursuing exchange development and are ready to roll out their own state exchanges by the 2014 deadline.

    The Branstad administration has stalled from day one, all while accepting significant federal dollars for exchange development. Too bad this administration isn’t as zealous in its efforts to improve health care access for the least fortunate among us.

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