Tag Archive: SBE

Health exchanges’ finances face test in 2nd year – US News

PROVIDENCE, R.I. (AP) — The federal government shelled out billions of dollars to get health insurance marketplaces going in the 14 states that opted to run their own. Now they must act like true marketplaces and start paying for themselves.

Under President Barack Obama’s Affordable Care Act, state-run health insurance exchanges need to be financially self-sustaining starting in January. Some appear to be on that path, while others have shaky funding models or even none at all.

Some states, prohibited from using state money, are imposing fees on plans sold on the marketplaces. Others are spreading costs more widely — which, in one instance, has drawn a federal lawsuit.

via Health exchanges’ finances face test in 2nd year – US News.

The AP reports state-based exchanges (SBEs) present a mixed outlook of their ability to operate financially independent of the federal government when federal exchange establishment grant funding ceases January 1, 2015. The less than certain finances of some SBEs could alter their relationship with the feds. In order to gain initial federal approval, SBEs were required to submit operational “blueprint” plans by January 1, 2013 showing how they intended to fund their operations after the grant funding ends.

Lacking adequate funding to be financially self-sufficient could put SBEs technically in violation of federal rules. States operating SBEs “must ensure that its Exchange has sufficient funding in order to support its ongoing operations beginning January 1, 2015…” (45 Code of Federal Regulations 155.160(b) – Financial support for continued operations.)


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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