Four states operating hybrid insurance marketplaces experience both advantages and disadvantages

The four states that operate their health insurance exchanges with support from the federal platform have primarily reported positive experiences, but challenges remain.

In a new report, the Commonwealth Fund examined the experiences of the state-run marketplaces in Idaho, Nevada, New Mexico and Oregon. The model allows the states to retain control of their marketplaces while containing costs. A fifth state, Hawaii, is slated to move to this federally supported state-based marketplace model for 2016 after financial struggles forced the state to close its existing exchange last September.

"We find that this model may offer states the ability to maximize their influence over their insurance markets, while limiting the financial risk of running an exchange," the Commonwealth Fund said in the report.

Policymakers and stakeholders reported positive experiences when using to determine consumers' eligibility for marketplace coverage and subsidies, allow them to shop for health plans and to get them enrolled, according to the report. The states also run their own branded websites and call centers.

However, the report did cite two disadvantages where respondents hope to see improvements: Better and more prompt access to application and enrollment data from the federal site and the need for better service from the federal call center for consumers who have questions or difficulties in the sign-up process.

At present, these states do not have to pay for use of the platform. "In 2014 and 2015, supported marketplaces have been able to use the federal technology without cost, thereby eliminating the pressure of financing one of the most expensive and complicated pieces of the exchange puzzle," the report stated. That will continue in 2016, but federal officials have indicated they intend to develop a lease arrangement for using the federal platform starting in 2017.

For states thinking of establishing their own insurance exchange, the model may be an option. As FierceHealthPayer previously reported, start-up costs of state-based marketplaces vary greatly. Additionally, state-run exchanges have had their issues, including financial struggles.

To learn more:
read the report