Just five years after the passage of President Obama's health care law, nearly half of the 17 state insurance exchanges are struggling financially, according to a new report from The Washington Post.
Rising costs and tepid enrollment numbers affecting many of the marketplaces set up by the states and the District of Columbia are forcing officials to consider raising fees on insurers and sharing costs with other states.
Some officials are pressuring state lawmakers for more cash infusions, while others are even considering turning over their marketplaces to the federal HealthCare.gov exchange, which has had its fair share of problems as well.
Hawaii, for example, has one of the most troubled marketplaces, as it needs $28 million just to keep operating until 2022, according to the Post. Without that money, "it's going to be very difficult to keep the doors open," the executive director of Hawaii Health Connector, Jeff M. Kissel, told the Post.
Oregon, on the other hand, already abolished its state exchange in March due to financial and technical problems, turning it into a gateway to the federal HealthCare.gov exchange.
The report comes at a critical time for the health insurance program: The Supreme Court is set to decide by the end of June whether consumers in all 50 states are eligible to receive federal tax subsidies, or if just those living in the states that created their own marketplace are eligible.
If the court rules against the Obama administration, subsidies for eight million people could be jeopardized. If it rules in favor of subsidies, struggling state exchanges could be quickly absorbed into the federal HealthCare.gov marketplace, something the Obama administration is already considering as a backup plan, one anonymous official told the Post.
In the most recent enrollment period, sign-ups in state marketplaces only rose 12 percent, according to the Post. That's compared to the 61 percent increase for the federal exchange.
To generate income, most states rely heavily on fees imposed on insurers, and those fees are based on the number of sign-ups, so strong enrollment is critical to the success of the exchange. States with the biggest financial problems are those with the smallest enrollment growth, according to the Post.
Many Americans believe the new health care law has negatively impacted the nation. A recent Fox News poll found that 42 percent of respondents believe their family is worse off under ObamaCare, with only 33 percent saying things are better now.
