Costs to enroll uninsured: State vs. federal exchanges

States that implemented their own health insurance exchanges spent three times more than the federal version to reach out to and educate consumers, according to a new study from the Robert Wood Johnson Foundation.

The 16 states that operated an exchange spent an average of about $17 per uninsured consumer, whereas the U.S. Department of Health & Human Services expended a little more than $5. And the five states that partnered with HHS to implement a joint state-federal exchange spent an average of $31 per person.

Although state-based exchanges enrolled more consumers than the federal marketplace, the study authors said that fact alone doesn't explain the difference in spending. State exchanges, for example, were backed by more than $3 billion in total federal funding to pay for enrollment assistance.

"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 RWJF, 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."

The study authors also noted that other influencers likely existed. For example, the analysis didn't account for some states and insurers that used enrollment buses like Independence Blue Cross in Pennsylvania to increase sign-ups. Also, navigators' efforts to enroll consumers, which varied widely throughout the states, weren't factored into the study.

Despite these limitations, the study authors believe their analysis can help states and insurers alike as they prepare for the next enrollment session.

"Such research could give us insights into the most effective use of resources, both public and private, financial and nonfinancial, as states prepare for subsequent open enrollment periods in the health insurance marketplaces," they wrote.

To learn more:
- here's the RWJF study
- see the Washington Times article