States Are Saying Bye to HealthCare.gov and Setting Up Their Own ACA Exchanges

New Jersey and Pennsylvania are the latest to set up state-based exchanges. Kentucky, Maine, New Mexico and Virginia, which currently have hybrid state-federal programs, are expected to be next.

A growing number of states are weaning themselves off of the federal ACA exchange, Healthcare.gov, and establishing their own state-based exchanges, according to the Center on Health Insurance Reform (CHIR) at Georgetown’s Health Policy Institute.

Kentucky, Maine, New Mexico and Virginia currently have hybrid programs that are state-based but use the federal platform. Those four states are scheduled to start their own platforms soon, Rachel Schwab and Nia Gooding wrote in a CHIR blog post last week.

According to the Kaiser Family Foundation, in 2021, six states have hybrid programs (Arkansas and Oregon are the other two) while 14 states and the District of Columbia have “pure” state-based exchanges (often called a marketplaces).

The 14 states operating state-based exchanges are California, Colorado, Connecticut, Idaho, Massachusetts, Maryland, Minnesota, Nevada, New Jersey, New York, Pennsylvania, Rhode Island, Vermont and Washington.

States are setting up their own exchanges because of greater autonomy, potential cost savings and possible innovations, wrote Schwab and Gooding in their March 24 post. But they also caution that “building up the necessary infrastructure and running a marketplace is no small undertaking.”

Their post focused on the state-based programs in New Jersey and Pennsylvania, which were new last year. During the open enrollment period at the end of last year ACA exchange enrollment increased by 21% in New Jersey and by almost 10% in Pennsylvania.

New Jersey officials report that a total of 269,560 residents signed up for 2021 health coverage through the state-based exchange, called Get Covered New Jersey, a total that includes, 75,749 new consumers.

Pennsylvania officials say enrollment through its state-based exchange, dubbed Pennie, now is about 338,000, including 75,000 new enrollees.

Schwab and Gooding noted that New Jersey and Pennsylvania have taken other steps to stabilize the individual health insurance market, such as operating a reinsurance program using the ACA’s Section 1332 waivers to reduce premiums. New Jersey also enacted a state-level individual mandate and enhanced premium subsidies, they said.