New Georgetown CHIR Report: In Trump Era, States Revisit the Benefits and Risks of Running Their Own Health Care Marketplace

By Sabrina Corlette, Kevin Lucia, Katie Keith, and Olivia Hoppe

On October 3, Nevada opened its new, state-run, health insurance marketplace for window shopping. After years of using HealthCare.gov, Nevadans will be able to receive financial help and select health plans via Nevada Health Link beginning November 1, 2019. Next year, New Jersey and Pennsylvania are slated to follow in Nevada’s footsteps, and New Jersey has announced a big boost in Navigator funding as it transitions to full state-based marketplace (SBM) status. New Mexico and Maine have also announced their intention to transition from HealthCare.gov to a state-run platform, and Oregon officials are considering it.

Why the sudden interest among states in abandoning the federally facilitated marketplaces? HealthCare.gov, by all reports, has been functioning well. In a new report published in partnership with the Urban Institute, we set out to find out what is motivating states to transition to full SBMs, assess the benefits and risks of such a switch, and identify considerations for other states considering a similar move. Major findings include:

  • The primary factors driving states to switch from the HealthCare.gov platform to a full SBM are the prospect of cost savings (and the ability to redirect those savings to other state priorities), an improved consumer experience, and regaining more autonomy over their insurance markets in the wake of federal actions to undermine the ACA.
  • State officials, insurers, consumer advocates and assisters identify several significant risks associated with a transition, including IT system failures or glitches, gaps in coverage or financial assistance for enrollees, and inconsistent federal policymaking.
  • Respondents cited a number of potential long-term benefits of establishing a full state-based marketplace, including alignment with other state health care priorities and the opportunity for more policy experimentation, such as a public option plan or Medicaid buy-in.
  • States considering a future transition to a full state-based marketplace should:
    • Know (and be able to articulate) state goals;
    • Set realistic expectations;
    • Allow for sufficient lead time to build and operationalize the marketplace IT and other infrastructure; and
    • Engage stakeholders early and often.

In general, states are viewing the transition to an SBM as a natural next step in their broader vision to reduce the number of uninsured and make health care more affordable. As one respondent put it: “States do this transition because they’re committed and want to help people have coverage.” All eyes are on Nevada—the first state making the transition back to a state technology platform—as an indicator of whether a stable and more efficient marketplace is a viable option. If Nevada and the other study states succeed, it is likely that more states will consider a transition to gain greater control and flexibility over their markets and capture potential savings that can be used for other state priorities.

You can read the full report here. Georgetown CHIR thanks the Robert Wood Johnson Foundation for its generous support of this project.

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