States’ Health Insurance Exchanges Prepare to Succeed

States that opted to operate their own health insurance exchanges have been making progress lining up insurers and expect to be ready to open for business on October 1st. In Oregon, Washington, and California, premiums will be lower than anticipated. In Colorado, 11 companies plan to offer 250 separate plans—an array of choices that may well require a navigator as the drafters anticipated.

Competition Under “Covered California”

On May 23, 2013, Covered California announced its selection of 13 plans. Although United Health, Aetna and CIGNA, three of the largest insurers, chose not to participate, the other major players did, including Anthem Blue Cross, Kaiser Permanente, and Blue Shield. And costs came in lower than expected. According to the online guide, the lowest cost silver plan for individuals is $304 per month; the average cost, $321.  Subsidies will be available to individuals with incomes up to 400 percent of the federal poverty level (FPL),  about $78,000 for a family of three. Blue Shield of California said that its individual policy holders would see an increase of about 13 percent over current rates. However, to the extent that the coverage is more comprehensive, the new plan still may be a better bargain.


Seventeen insurers submitted more than 800 proposed plans to the Colorado Division of Insurance. The agency has tentatively approved 250 plans offered by 11 insurers. Although not all of them will meet the standards for qualified health plans (QHPs), the agency expects to have plenty of choices available.  Review should be completed by July 31st. The premiums vary widely among plans, the agency says.


Oregon released the plans and the rates the insurers proposed for the health insurance exchange on May 9, 2013. When the monthly rates for a 40-year-old nonsmoker in Portland ranged from $169 to $422, two insurers at the high-end promptly filed requests to reduce the rates, even before the scheduled hearings or the final approval. Both insurers stated they wanted to be competitive. As Nick Rudnick at The Oregonian reported, “This is what competition looks like.”


According to the website for the state’s health insurance exchange, nine insurers have filed 57 proposed plans for approval. The exchange for individuals will open on schedule. However, the small business marketplace will open as a pilot project in a few counties, yet to be selected, with limited participation by insurers in October 2013. Next year, the program will be operational statewide.

Although all health plans in Washington currently cover abortion services, two insurers filed proposed plans without that coverage.  Kaiser Foundation Health Plan of the Northwest said that the exclusion was an error and would be corrected. The other insurer, BridgeSpan, is reassessing its offering and intends to include abortion coverage.

Idaho and New Mexico Ask for Help

Idaho and New Mexico both had been approved to run their own exchanges. However, on May 23, it was reported that they had asked for federal help. Idaho has asked to use the federal government’s computer platform for the first year only because of concerns that its own platform would not be ready in time for open enrollment, which begins October 1, 2013.  Governor Butch Otter says that Idaho’s exchange will not be a “federal partnership;” residents will still have a consumer-friendly Idaho exchange, but the eligibility determinations for premium subsidies will be made through the federal platform.

New Mexico also faced problems with getting the computer system up and running. The state will continue its plan to offer the small business options program on its own, but it will depend on the federal government to make determinations for individuals’ eligibility because of the need to interface with other programs, such as Medicaid and the Children’s Health Insurance Program.

Maine’s Federal Health Insurance Exchange

Despite worries that the federally operated exchanges may not open in time, Maine’s federal exchange has made significant progress.  Two insurers currently are expected to offer plans in Maine. A consumer-operated nonprofit insurer, Maine Community Health Options (MCHO), has contracted with a major provider network, the Kennebec Region Health Alliance, a physician group operated by MaineGeneral Medical Center to serve residents. It is reported that MCHO is building a statewide provider network and hopes to enroll 50,000 members for 2014.