December 2, 2013
WashingtonState has chosen to develop a separate Health Exchange for the Affordable Care Act (ACA). Another 13 states are also developing their own Exchanges, while 36 states are being served by the federal Exchange at www.HealthCare.gov.
Elder law and health law practices in Washington will be substantially affected by how well ACA implementation proceeds in the State.
According to a recent report by the Washington Exchange, as of November 14, 2013, enrollments had been completed for about 100,000 residents—about 12,000 for Qualified Health Plans (QHPs) and the balance for individuals seeking coverage under the expanded Medicaid program.
Another 160,000 applications were in process.
The Washington Exchange was set up as a public-private partnership. The Exchange is separate from the State and is governed by an 11-member Board.
As noted in a recent newspaper article (by John Webster, appearing in the Spokane, WA Spokesman-Review, November 16, 2013), the communications director for the Washington Exchange has stated that the Exchange “barely worked” on October 1, but performance increased rapidly, as “bottlenecks” between different parts of the site were improved.
As further stated, the developers continued to be “sensitive to user feedback”.
Implementation is going so well that Washington State has declined to allow existing insurance policies to continue into 2014.
The contrasts between the federal Exchange and Washington State Exchange are substantial. It would be useful to be able to draw generalizable lessons from this contrast—for future reference.
Some of the differences may relate to factors of scale, since the federal Exchange must handle so many more enrollees, and to political environments that are quite different (with general support in Washington State and substantial conflict at the federal level).
The two Exchanges are set up as quite different types of organizations (one as part of a federal agency and another as a public-private partnership separate from state government).
There is a fair amount of transparency for the Washington Exchange, but less for the federal Exchange—except for the names of the contractors involved.
Relative funding levels and problems might also be examined in any comparisons.
It would be helpful to be able to review a detailed evaluation that has considered such parameters, in order to better understand present ACA activities and prepare for other federal and state program changes in the future.
For now, attorneys can draw upon their own experiences to assess why the Washington Exchange has been relatively successful, and can begin the process of integrating these insights into their practice strategies.
Elder law practice in Washington is discussed by Cheryl and Ferd Mitchell in volumes 26 and 26A of Washington Practice (Washington Elder Law and Practice and the associated Elder Law Handbook). Probate practice is covered in volume 26B.