Several years ago, before the decision to allow states the ability to run exchanges was announced, some observers noted the allure of a single federal platform for exchanges. The drawback to state-run exchanges is the complexity that results from up to 50 different sets of exchanges. A federally run exchanges can offer consistency across the country. Further, non-discrimination rules and “minimum essential coverage” rules and standards can be more easily monitored in a federal exchange as compared to many models in state exchanges.
Employers with operations and employees in many states, and health plans as well, would appreciate a standard set of rules; for these organizations, navigating a single system may be the better option.
These decisions by states are not final – states annually have the option of starting an exchange, and a standard for exchanges could prove to be the “template” for newer models. We will all see how this develops, but I wouldn’t be surprised to see consolidation in these exchanges of the future, rather than re-inventing the wheel 50 times.
Michael Taylor, MD
Chief Medical Officer