Do you remember when HealthCare.gov was such a mess that people were praising the state-run exchanges as a model of how things could and should be? Well, things have changed. Some exchanges, like Oregon, had starts plagued with just as many problems as HealthCare.gov, but now five state exchanges – Maryland, Massachusetts, Minnesota, Nevada and Oregon – are in need of serious fixes.
And it won’t be cheap. According to the Wall Street Journal, states need some $240 million to fix their sites or transition to using the federal exchange. That’s on top of the $700 million in federal money these states have already spent or committed to spending on the exchanges. And whatever amount of new money they spend from the feds will have to be added to the already $4.7 billion in grants the feds made to states overall.
Here is a table that may make your taxpayer skin crawl:
What are the consequences for the states’ incredibly bad performance and high costs? Who’s being held accountable for this mess and the cost overruns that followed? (You can read more details here.)
Even when states actually managed to start successfully enrolling people in their exchanges, the number of enrollees has made the systems look remarkably expensive. The per-enrollee cost of the state exchanges is much higher than what it is on HealthCare.gov, which was an already steep $647 per person. Here is a summary from Kaiser:
As rocky as its rollout was, it cost the federal exchange, HealthCare.gov, an average of $647 of federal tax dollars to sign up each enrollee, according to a new report. It cost an average of $1,503 – well over twice as much – to sign up each person in the 15 exchanges run by individual states and Washington, D.C.
The report, released Wednesday, was compiled using data from federal enrollment figures and federal exchange funding for both the federal and state exchanges. It was written by Jay Angoff, a former Missouri Insurance Commissioner and one-time director of the Health and Human Services office in charge of implementing the health exchange program.
Even California, the most efficient of the state-run exchanges, at $758 per enrollee, still spent more than the average in the federal exchange. And California was the only state-run exchange with a per-person average under $1,000.
Hawaii, with a combination of a poorly-functioning website, a small population overall, and a small population of uninsured, brought up the rear in the study. It cost the Aloha State an average of $23,899 per enrollee covered. Washington D.C. came in next to last at $12,467 per person.
The whole thing is here.