In the initial stages of support seeking and lobbying, the nation was divided into two parts over Obamacare – states that sided with the administration and were ready to prepare their own state exchange in support of the act, and those that disagreed with the state exchange strategy and put the onus of creating the exchange on the federal side. Out of those states that made their own exchange, several were successful in delivering a solution that could enroll Americans conveniently, while others were tied in fate to the fall of the federal exchange. However, not all states that created their own exchange were successful.

The big 4 – Massachusetts, Maryland, Nevada and Oregon, built their own exchanges, but suffered immensely due to lack of enrollments, poor technical systems, etc. From embracing Obamacare & preparing their own state exchange in support of the act, to collapsing into a failure & being unable to enroll Americans, Maryland, Oregon, Nevada and Massachusetts state exchanges will each need a new strategy that saves taxpayers money and resuscitates the dream of a working state exchange. Let’s take a look at how each state is planning to emerge from this crisis.

Massachusetts, known to be a pioneer in health reform, is taking an approach that’s meant to make headway in two directions – constructing a state exchange while relying on the federal exchange as a backup plan. Known as the ‘Massachusetts dual-track’ approach, it will focus on creating a new exchange solution that will replace the Massachusetts’s Connector, and simultaneously, will prepare the state to connect with the federal exchange in case the new exchange solution does not perform. hCentive, post our success in Kentucky and Colorado, has been chosen  as the partner who will help Massachusetts create a new state exchange solution.

State Exchange

Oregon, one of the first states to adopt the state exchange plan, suffered the biggest setback in enrollments through its exchange. After a big financial setback and multimillion-dollar failure, Oregon is switching to the federal exchange and scrapping its individual health exchange. The cost to fixing the complete Oregon exchange and resolving all the involved complexities would cost the state about $80 million, as opposed to $4 to $6 million if they move completely onto the federal exchange. It is disappointing that after spending nearly $135 million on making its state exchange, Oregon is moving to a federal exchange.

Nevada is currently undecided on the path to take, and is taking the help of Dell Consulting, at the cost of $1.5 million, to figure out the problems and possible solution to fix Nevada Health Link. Xerox, which won the contract for making Nevada Health Link, could not deliver on its promise. Now, Nevada is either going to move completely to the federal exchange, or find a way to fix its health exchange. The entire game rests on what Dell Consulting reports for the exorbitant price it has commanded.

Maryland has also planned to fix its own health exchange and take what worked in Connecticut and implement it “As Is” in its own state. Just like Nevada, Dell Consulting is going to assist Maryland administration in identifying the main problems of the exchange and implementing the solution that worked for Connecticut. The state would require more money from the federal government, but a lot is going to depend upon whether the center considers this approach viable. If not, federal government might put pressure on Maryland to go the Oregon way and join the federal exchange.

Each of the big 4 has a plan in place to tackle the existing challenges and emerge victorious from this failure. While Nevada and Maryland still have some uncertainty in their plan and are waiting for Dell to deliver, Massachusetts and Oregon have already taken a step further and have put the wheels in motion. We are seeing all kinds of strategies to tackle this problem – dual channeled, federal defection, and new implementation; let’s see what works for each of these states.

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