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Editorial: States take different paths on question of health exchanges

Nov. 29, 2012 @ 11:35 PM

The next big decision on health care reform is coming up, and it appears states in our region all are taking different approaches on "health exchanges."

One of the key provisions of the Affordable Care Act is to push more people to get health insurance in hopes they will receive more consistent medical care for themselves and their families. At least some portion of the nation's rising health care costs stems from a lack of preventative care and poor management of chronic illness. More regular visits to the family doctor and fewer trips to the ER should help, experts say.

About 16 percent of Americans do not have health insurance. So, closing that gap is a good idea, but the debate continues about how to achieve that goal.

The ACA asks states to set up a "health exchange" -- an online marketplace that would allow people who do not have coverage to shop for health insurance. The exchange would be designed to unite their buying power, make comparison shopping easy and help individuals, families and small businesses find the right fit. Private insurers would compete for the business, but the insurance would have to meet minimum standards.

If the states decide not to set up a health exchange, the federal government will set one up for them. The plan is to have exchanges set up by the fall of 2013 so individuals can get insurance in place by January 2014. That's when most Americans will be required to have health insurance or face a penalty.

In our region, Kentucky is among the 17 states that have decided to run their own health exchange. All but four of those states have Democratic governors. Ohio is one of 17 states that have said they will not set up an exchange. All but one of those states have Republican governors.

West Virginia is one of the states that remain undecided, although there are indications it will choose to partner with federal government on an exchange as several other states are planning to do.

The deadline to decide is currently set for Dec. 14.

For West Virginia, at least, the decision to partner probably makes the most sense. State officials estimate the potential buyers in the state might be 40,000 to 60,000, a relatively small pool, and the set-up costs could be high for administration and operation.

A federal exchange could bring economies of scale and result in lower prices for the consumer. Meanwhile, the state could focus its efforts on educating residents about the new opportunity. That could also include the larger question of whether to expand Medicaid to cover more people, and ACA provides incentives for states to do that.

But experts also think the exchanges alone are likely to add to states' Medicaid expense with residents who have always been eligible but were not enrolled. So, either way states are wise to brace for higher costs in the years ahead.

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