Federal exchange a bargain compared to state-run exchanges


Despite the unreliable and glitchy HealthCare.gov site, the federal exchange spent only $647 tax dollars to enroll each individual. Meanwhile, the 15 states plus the District of Columbia running their own exchanges spent a whopping average of $1,503 per person, according to a report released Wednesday by Jay Angoff, a former Missouri insurance commissioner and one-time director of the U.S. Department of Health and Human Services office in charge of implementing the health exchange program.

HHS on May 1 detailed the number of people who enrolled in exchanges and the amount spent on creating the online marketplaces. Angoff combined HHS exchange enrollment data through March 31 with HHS exchange funding through March 31 to calculate the cost spent on each enrollee at the state-level.

He found some alarming differences: The state with the lowest-cost-per-enrollee was California, at $758, while Hawaii, with its disastrous website and small population, took the cake by spending $23,899.

What was not expected was that states whose legislatures resisted the Affordable Care Act--Florida, Texas, Georgia, Virginia and Michigan--ended up spending the least per enrollee. For example, Texas spent only $102, while Florida spent $76, reports Kaiser Health News.

Yet when excluding the two state-run exchanges who dished out the most funds--outliers the District of Columbia and Hawaii--the pioneer state for the online health insurance market, Massachusetts, spent the most per enrollee, at $5,681, finds the study.

The state plans to temporarily join HealthCare.gov due to current issues with its online site, reports the Boston Globe. Since its launch in October 2013, the site has experienced endless flaws, forcing the state to enroll residents through the state Medicaid program.

What's more, all of the states with high costs per-enrollee have relatively small populations, notes KHN.

"The availability of federal money and the type of marketplace were huge factors in the amount states spent to enroll the uninsured," Katherine Hempstead, who leads coverage issues at the Robert Wood Johnson Foundation, recently told the Washington Times. "The real question, which can only be answered in time, is how big of a role states' consumer assistance programs played in overall enrollment success," FierceHealthPayer previously reported.

For more:
- here's the report from Jay Angoff (.pdf)
- read the Kaiser Health News article
- check out the Boston Globe piece

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