Two-Thirds of Exchange Enrollees Will Buy Through Federally-Administered Exchanges in 2014
With tomorrow's deadline looming for states to decide whether they will operate their own insurance exchange or default to the federal government, Avalere Health estimates that nearly two-thirds of all likely exchange enrollees will receive coverage through a federally-administered or partnership exchange in 2014.
Those states that fail to establish their own exchange will have the option to partner with the federal government on issues related to plan management and consumer assistance, or they can fully opt-out and have a completely federally-run exchange. As of December 12, there are 17 states and DC that have committed to running their own exchange, and Utah is pursuing approval for its existing exchange. These states are expected to enroll 2.8 million individuals out of a total of 8.2 million people nationwide who will buy coverage through exchanges in 2014. Avalere's estimates are based on its proprietary enrollment model that predicts sources of insurance coverage by state for the next 10 years.
Because the majority of exchange enrollees will access coverage through systems that are operated by the federal government, key federal decisions about plan participation, the consumer interface and outreach activities, eligibility and enrollment, and options for small businesses will have a crucial impact on individuals' experiences with the exchanges. Guidance on how the federal exchanges will operate many of these functions is still outstanding.
State decisions about Medicaid expansion will also impact exchange enrollment. States that do not expand Medicaid for newly-eligible individuals will have higher exchange enrollment because individuals earning more than 100 percent of poverty will receive coverage through exchanges. To date, 10 states have indicated that they will not expand their Medicaid programs. Because states that are using federal exchanges have been more likely to reject the Medicaid expansion, the portion of exchange enrollees buying insurance through federally-run exchanges could continue to rise.