As federal officials work to create the health insurance exchange to be implemented in any state not operating its own marketplace, they've kept most of the details out of the public's eye--quite a contrast from many states' exchange-planning activities.
The federal exchanges are "much more opaque" than state exchanges, Sabrina Corlette, research professor with Health Policy Institute of Georgetown University, told The New York Times.
That means insurers are left in the dark regarding specific requirements they must comply with when selling plans on the federally run exchange.
"We have gotten little bits of information here and there about how the federal exchange might operate," said Linda Sheppard, a senior official at the Kansas Insurance Department.
For example, some states, including California, Minnesota, Mississippi and Nevada, have dedicated websites for documents that include their exchange groundwork, including minutes of public meetings, cost estimates and information about contracts. California has even released a detailed work plan for its exchange, summarizing its process thus far and setting out future plans on a month-to-month basis, according to California Healthline.
But the U.S. Department of Health & Human Services hasn't disclosed its exchange plans, financing information or "request for proposals" circulated to advertising agencies. And they don't have a federal exchange website.
"Nobody has any idea what the federal exchange will look like," Thomas Harte, president of New Hampshire-based Landmark Benefits, which arranges health insurance for employers, told the NYT. "There has not been much communication between officials drafting plans for the federal exchange and the people who will use it."
HHS also requires state exchanges to develop a budget, including expected operating costs, revenues and expenditures, but it hasn't yet disclosed its own budget for the federal exchange. HHS officials have revealed that they will charge participating insurers user fees but haven't explained whether insurers can pass those fees onto consumers.
Meanwhile, insurers and lawmakers have questions about how the exchanges will operate. Insurers, for example, want to know what benefits they must offer in order to sell plans within each exchange, reported CQ HealthBeat. And some legislators want HHS to clarify whether the federal exchange will be standardized or at least partly customized to each state, as well as how it will set insurers' network adequacy levels.