Tag Archive for Exchange

Texas Groups Promote Health Exchange Without Help From State

Texas officials have declined to establish a state-based health insurance marketplace, a major provision of the federal Affordable Care Act. So private organizations are working to educate Texans about coverage options through the federal health insurance exchange, which opens on Oct. 1.

Of the more than 6.3 million uninsured Texans — the state has the country’s highest rate of uninsured residents — almost half will be eligible to buy insurance through the federal exchange, an online tool for coverage shopping.

But Texans suffer from a “general lack of knowledge” about the law, said Allison Brim, a director at the Texas Organizing Project, one of several groups working to reach uninsured families before the federal exchange’s rollout.

“Folks just don’t have a lot of information about the exchanges and what their options will be,” she said.

The Texas Department of Insurance has made no extra effort to publicize the federal exchange, said John Greeley, an agency spokesman. In 2010, it conducted a federally financed campaign about health insurance options but has done nothing comparable since, he said, adding that those with questions could use the department’s website or telephone service.

Brim criticized the state for not promoting the exchange, saying its help would make it possible to reach all eligible Texans by October.

“The state has, as far as we know, done nothing to spread the word to uninsured Texans about the exchanges or the Affordable Care Act,” she said. “It leaves a mountain of work for us.”

In response to questions about publicizing the exchange, Lucy Nashed, a spokeswoman for Gov. Rick Perry, wrote in an email that the state was “not interested in implementing Obamacare, including the exchange.”

On July 10, a division of the U.S. Department of Health and Human Services awarded about $9.9 million to Texas community health centers to make people aware of their options.

The department will also finance at least two “navigators” — organizations intended to guide people through the exchange — per state. Texas’ navigators will receive about $8 million.

But Jacob Cortes, the lead organizer of the group Austin Interfaith, said that might not be enough. “The private sector would have to step up,” he said.

Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services, said navigators were just one federal resource. The agency also dispatches officials from its Dallas office and Washington headquarters to speak with health workers and organizers in Texas.

And it collaborates with local initiatives, Bataille said, including groups like Blue Cross Blue Shield, which started a Be Covered campaign; the Texas Organizing Project; and Enroll America, which promotes the health care act.

Be Covered has joined with churches, museums and other organizations in every Texas county to distribute literature on obtaining insurance, said Michelle Riddell, a Blue Cross Blue Shield of Texas spokeswoman. 

The Texas Organizing Project and Enroll America are canvassing and organizing community meetings where Texans can get more information.

Reaching exchange-eligible people will not be easy, said Mimi Garcia, Enroll America’s Texas director. She added that groups like hers will have to work beyond January 2014, the deadline for Americans to obtain coverage.

“I would love it if we could get everybody enrolled in the first year and that would be it and we would be done,” she said. “But that’s not going to be the case.”

Cortes said ambiguity about the federal exchange — including yet-undetermined providers and premiums — make it difficult to spread a clear message.

Texas’ size poses another challenge, Brim said, because in rural areas “we just can’t reach as many people as fast.”

“There will be some folks,” she added, “who just don’t get the word.”

This story was originally published by The Texas Tribune, and was produced in partnership with Kaiser Health News.

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Federal Data Hub Hobbling Health Exchange Implementation

The federal data hub intended to connect state health exchanges with federal agencies appears to be the most significant hurdle for a timely launch of the insurance marketplaces, according to a new Government Accountability Office (GAO) report.

Seven surveyed states identified the hub as “the major operational challenge” that they face, according to the GAO. Whether that challenge is resolved could determine whether the exchanges are ready to open on Oct. 1, 2013, the date set for their launch by the Affordable Care Act.

“States said, by and large: We’re doing the best we can. We’ve been doing this a while. We think we’re going to be ready, but it’s anybody’s guess because it’s so evolving, especially with the data services hub,” says Stan Czerwinski, who headed the group that authored the GAO report. “State systems have to connect with federal systems, which are still being developed. The challenge is hooking into these systems without knowing what they will look like.”

The data hub — in laymen’s terms, a huge digital warehouse capable of sending information to other online servers — plays a crucial role in the exchanges, which are websites that will allow the uninsured to shop for health coverage and access federal tax subsidies to help them purchase it. The tax subsidies, for example, are supposed to be based on a person’s income; the lower your income, the higher your subsidy.

The exchange is supposed to transmit the income information entered by an applicant to the hub, which will then verify the information with the Internal Revenue Service. That verification is then transmitted back to the exchange, so the person can access their subsidy. The hub will also relay information between the exchanges and other federal agencies, such as the U.S. Citizenship and Immigration Service and the U.S. Department of Homeland Security.

It sounds simple, but it’s a significant headache for the 17 states that, so far, are building their own exchanges. For starters, the hub hasn’t been completely built yet, nor have the rules that will govern its use been finalized. Because tax information will be exchanged through the hub, there is a laundry list of privacy and security standards that must be met. In addition, the IRS is accustomed to receiving and then processing this kind of information over long periods of time, up to a month, while the exchange is supposed to provide verification in almost real-time. Nobody is sure if and how the hub will be equipped to handle that workload.

All the while, states are already building the technical infrastructure for their exchanges, which includes a website and an eligibility system, without knowing exactly how their exchange is supposed to connect with the hub. It’s a major problem with four months left until the exchanges are supposed to be operational, and Czerwinski believes “this is going to go way up until the very last day.”

One state was so pessimistic that officials told the GAO they expected to be still modifying their exchange’s IT infrastructure to connect with the hub into 2014. For its part, the Obama administration told the GAO that it had provided states with information on how to connect with the hub through webinars and conferences, though that apparently has not assuaged states’ concerns.

“Until they’re able to do this testing to make sure that all these points connect, it’s still unknown,” Czerwinski says. “I think they agree that it’s the biggest challenge area and will need adjusting from day one.”

Caroline Pearson, who tracks state ACA implementation at Avalere Health, a consulting firm, said the GAO report underlines an overarching problem with health exchange IT development: it’s hard to know how states are doing. Some steps, such as accepting applications for health plans to be sold on the exchanges, are public, but the GAO’s findings are one of the few public disclosures of progress on the IT side.

“This does feel like an area where there could be pitfalls in rollout. There are a million ways it could go poorly,” Pearson says. “We have touch points and checkpoints on so many other things. All of that is a little more public, but it is really hard for me to assess whether a state’s exchange is going to crash on Oct. 1.”

Officials at the U.S. Department of Health and Human Services did not immediately respond to requests for comment. GAO interviewed officials from the District of Columbia, Iowa, Minnesota, Nevada, New York, Oregon and Rhode Island for the report.

This story was originally published by GOVERNING magazine.

Photo from Shutterstock.

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First Dual-Model Health Exchange to Debut in Utah

An effort by Utah — to continue to run its small business health insurance marketplace alongside a yet-to-be-created individual health insurance exchange — has been given the green light by the federal government. According to a report on NPR, Utah Gov. Gary Herbert made the initial request in February, which was followed by months of negotiations. A letter sent to Gov. Herbert May 10 announced the approval of the arrangement. 

“They’ve granted us everything that we asked for, and for that I’m grateful,” Herbert said in a call with the media on May 10, praising Health and Human Services (HHS) Secretary Kathleen Sebelius for her flexibility in the negotiation process. Other states can consider a similar set-up once the HHS officially approves the rule change for Utah.

What sets the system in Utah apart is that the two exchanges will operate independently of one another. This arrangement means, for example, that the state will not provide information about participating residents and businesses for inclusion in federal databases. It is unclear at this point how Utah consumers will be able to compare plans available under each exchange when deciding on coverage.

Until now, states have selected from one of three options in implementing the exchanges, which are being set up in accordance with the Affordable Care Act, which takes effect in January 2014. Seven states have chosen federal/state partnerships, in which the two levels of government work together. State-run health insurance exchanges are being established by 17 states, while 26 states will default to an entirely federally run program for their residents.

36 Hours Behind Rhode Island’s Health Exchange

The Rhode Island health insurance exchange lives behind an unassuming and unmarked door in the basement of the state department of administration building in Providence. That’s where the operation’s brains are: the staff of twentysomething charged with implementing one of the least understood but most important parts of the Affordable Care Act. At its most basic level, the exchange is intended to be an insurance marketplace, a website where people can shop for health coverage and access federal tax subsidies to help them buy it. The staff in Providence want it to be much more than that, but first, they have to get it ready for launch.

Their corner of the basement, lined with makeshift blue cubicles, used to be the building’s gym. Once in a while, a sweat-soaked state worker will shuffle through to the locker rooms along the back wall. There are no windows, just walls; the staff colloquially calls it “the dungeon.” There is nothing glamorous about this job. A recent survey found that nearly 80 percent of Rhode Islanders don’t even know that these people are doing any work at all, much less that they’re sometimes staying to midnight to get that work done by the Oct. 1, 2013 deadline set by the Affordable Care Act when it was signed by President Obama in March 2010. Gov. Lincoln Chafee created the exchange on Sept. 19, 2011, via executive order, and it’s been a race to meet what was always an aggressive timetable.

Moreover, this isn’t like other government programs. Everybody around here, most of whom have spent some time in the private sector, emphasizes how creating the exchange, which centers on launching a complex yet functional and usable website, is more like working at a commercial start-up. This isn’t some entitlement program with automatic eligibility and a strict set of benefits. Dharma Yechuri, a private consultant who came from Blue Cross/Blue Shield in North Carolina, explains that the whole enterprise boils down to getting a segment of state government to think like “a product-centered business.”

Ian Lang, the exchange’s director for marketing and communications, puts it another way: “We’re asking people to change their buying habits. We’re asking them to buy this product.” In many ways, that’s a totally new role for government.

To help do this, Rhode Island has $60 million in federal dollars—think of it as venture capital—and less than five months to finish the job. But they still must deal with the bureaucratic processes and inflexibility built into state government, including cumbersome purchasing and contracting rules. A private website could push back its launch if things weren’t ready when they were supposed to be. The Oct. 1 opening for the exchanges, by contrast, is written into federal statute. “10-1” is the mantra throughout every meeting.

With so little time left, nerves are clearly wearing thin, though the staff tries to put on a brave face because these are people who genuinely believe in what they’re doing. Everyone looks a little frazzled as the data and evaluation team gathers on a May afternoon. No time to spare: it starts at noon sharp and the mismatched fold-up tables that serve as a conference room are littered with plastic tubs and half-eaten salads. As one person tries to remember if they actually sent someone that thing they were going to send them, others are visibly frustrated. Throughout Governing’s 36 hours at the exchange, staff members would vent a little frustration, then hastily add that the previous comment was off the record.

At one point, a data analyst pulled migraine medication out of her purse and popped a dose before handing the bottle to the colleague on her right.

“We have to self-medicate,” she said wryly. She was kidding, of course. Mostly.

That’s the tone as the clock ticks toward the first of October. But despite the general feeling that everybody’s a little on edge, they’re also consistent in their confidence that they’ll be ready. To be frank, they better be. Rhode Island is one of 17 states that volunteered to set up an exchange themselves, rather than let the federal government do it. Some are already speculating that the implementation of the ACA’s final major reforms next year, and its relative smoothness, will be a major factor in the 2014 midterm elections. The exchanges are the big, shiny new object of the group, new entities created specifically by Obamacare with which the general public will interact. It will be the first conscious contact with the law’s reforms for many people, up to 20 million nationwide and more than 850,000 Rhode Islanders.

So the Rhode Island exchange’s staff keeps pushing onward, testing daily whether government can function like a business. Exchange Director Christine Ferguson, a former Commissioner of Public Health in Massachusetts and U.S. Senate staffer, says this is the most challenging thing she’s ever attempted after more than 30 years in government.

“What we’re doing is we’re taking something that people have to buy and we’re trying to ensure that there’s a value proposition for people who need to buy. That is far more like a private sector enterprise than a public sector enterprise,” she says. “I’ve posed this to a number of people, and none of us can come up with anything that government has ever done in any sector where that’s the case. This is different than anything that’s ever been done before.”

The cornerstone of any successful business is a good product. The exchange’s product is an experience, the relatively simple and seamless experience of shopping for and purchasing health insurance. For the customer, it’s supposed to be as easy as entering some basic information (the size of your family, your income, etc.), sifting through the available plans (helpfully labeled by colors such as gold and bronze to signify their level of coverage), and then automatically accessing tax credits to help purchase the one they want.

But for that process to be effortless for the end user, the exchange has to perform a lot of work behind the scenes. That’s where Brian Keane, a principal at Deloitte Consulting, which is building the exchange’s website, and his team take over. They have to launch a website that’s analogous to Expedia or Travelocity—though much more complicated—in the next five months. It has to synthesize information from the four insurers offering a combined 28 plans on the exchange into something that the lay person can understand. It has to send and receive information from a federal data hub that will determine whether people are eligible for help in purchasing their insurance and how much help they’re allowed to receive. Between 2,000 and 5,000 federal rules must be coded into the exchange’s software infrastructure. All of this has to be condensed into an easy web experience that won’t discourage the average Rhode Islander so much that they give up; Keane describes the actual consumer interface as the tip of the exchange’s proverbial iceberg.

Sitting in a Providence hotel room that has become his second home, Keane appears put together. His voice, with a light Irish accent softened by a quarter-century in the States, exudes confidence. He habitually knocks the wooden table to retain good luck. But he admits that an hour earlier, his team of 14 had been squeezed into this tight space, scrambling to get a demo of the website ready for a presentation with state officials later that afternoon. They’re happy with their work, though not happy enough to let Governing observe the presentation.

Deloitte is building exchanges for four other states, and that’s a good thing, Keane says. The company began its work for Rhode Island in January, which would mean they had 10 months to get the website ready for launch. “That would have been insane,” Keane says. But because they’d already done some work for other states, they had a head start here. So despite a lot of speculation in the policy world that the exchanges might not be ready on time, he pledges Rhode Island’s will be.

“We will deliver. The solution will be delivered. We’re testing for problems as we go along,” Keane says. “We won’t let the system turn on if it’s not ready, but even with all the time in the world, there’s always a couple of bugs and things to be addressed.”

But the website is just a part of the overall exchange. The state is also constructing a call center, so those who feel more comfortable buying insurance while talking to someone on the phone will have an alternative. It has to be able to handle more than 64,000 calls per month. Then, like any other good business, the exchange needs a customer service arm to handle the inevitable inquiries of confused or annoyed customers. That will include the call center and an online help section, as well as dozens of independent contractors called ‘navigators’ who will be scattered throughout the state. Lastly, and certainly not least, it requires a big marketing component to make sure those 80 percent of Rhode Islanders who don’t know about the exchange yet will be well aware of it by the time it opens. Like any fresh start-up, the staff conducts thorough market research, surveying the public on details as minute as the exchange’s tagline (“Your health. Your way.” and “We’ve got you covered.” tested well.)

Overhanging everything is the federal Center for Consumer Information and Insurance Oversight, the federal agency tasked with supervising the implementation of the exchanges. They’re the omnipresent overseer, constantly holding calls to offer support and make sure the exchange is following the rules and regulations that CCIIO crafted from the ACA’s provisions. During the data and evaluation meeting, one staff member ticks through the materials that the federal agency wants submitted in the next few days before being stopped by a colleague.

“They never told us that before!” the colleague said.

With every step, the bureaucracy of government adds an extra hurdle to the exchange’s development that some upstart Silicon Valley outfit would never encounter. Lang explains it like this: if he was working at a private company and needed to hire a marketing firm to push its product, he could probably do it within a week. Find a good partner and sign a contract. But to do the same thing for the exchange, he has to go through the state’s purchasing procedure. Put out a request for proposal and leave it open for a set period of time. Collect the offers and post them for public comment. Then clear the contract with the attorney general’s office. The whole process can take a month or more, while the Oct. 1 deadline moves steadily closer.

“Government doesn’t turn on a dime, and it shouldn’t with the public’s money. But there’s a tension there,” Lang says. “Government isn’t usually an incubator for this kind of work. You have to get people to buy into the concept. It’s a leap.”

A lot of reputations ride on the exchange staff overcoming the aggressive timetable and onerous inconveniences that come with being a business within a government construct. That starts with the governor. Chafee issued his executive order because the state legislature wouldn’t agree to a bill to create the exchange. In a sense, he took ownership of its success or failure. Lt. Gov. Elizabeth Roberts has been the chairwoman of the state’s health care reform task force, overseeing all of the ACA implementation, but particularly the exchange. She has a health care background and plans on leaving office when her term expires in 2015. She knows her eight-year tenure will largely be viewed on whether she adequately prepared the state for Obamacare.

“This is what I really have a passion for. Health care is one of those issues that can be a political winner and a political loser,” Roberts says. “We are going to work as hard as possible to leave things moving in the right direction. I want to do as much as I can while I have the chance.”

Then there’s Ferguson. If the exchange is a corporation, then she is its CEO. She plays the role well; during a board meeting, she’s the one with all the answers, the person to whom participants direct their questions. She’s been around government a long time, heading state departments in Massachusetts and Rhode Island as well as serving as a top adviser to Chafee’s father John in the U.S. Senate in the 90’s. She rattles off a list of adjectives to describe her current state of mind—“clear”, “targeted”, “nervous”, “anxious”—before adding a superlative kicker: “Negotiating with Clinton was easier than this.”

She’s been the one responsible with transplanting the commercial start-up mentality into the Rhode Island State House. She’s added a lot of corporate-minded people to do it, people like Yechuri, Keane and Lang, who left a job at his own consulting firm to head the exchange’s outreach effort. The outcome largely rests on her shoulders. Win or lose, Ferguson is the face of the enterprise. She knows it, too: “I don’t sleep a lot,” she says with a laugh.

Despite all the tangible tension, the exchange staff is uniformly expecting a win. They’ve already scored a big one in their minds: the exchange will offer full employee choice for employees of small businesses next year. That means individuals will be able to pick their own plan, rather than relying on their employer. The federal government has already said it’s postponing employee choice until 2015—they’re stuck with one plan selected by their company—so the Rhode Island staff takes great pride in having it ready for the launch. It’s a significant change from the pre-ACA norm, Ferguson says, and it’s important in getting the public to buy into the exchange.

But they’re also preemptively managing expectations. Almost everybody acknowledges that there will be problems on Oct. 1. That recognition has ascended all the way up to U.S. Health and Human Services Secretary Kathleen Sebelius and even President Obama himself. But the goal is to keep those problems to a minimum and as invisible to the public as possible.

Five months from product launch, nobody can say for sure what the exchange’s opening will be like. But its leaders are already thinking ahead. They envision the exchange as more than an insurance marketplace. They have hopes of creating a base for improving Rhode Island’s overall health. They want to allow employers to track how many days their workers miss for preventable reasons. They want to help consumers find health care providers and then rate and review them. They want somebody to be able to come onto the exchange, apply for an insurance tax credit, and find out if they’re eligible for food stamps or other social programs while they’re at it. That’s the grand vision that keeps these people working hard, the motivation that has Lang still juggling his Blackberry and iPhone at his son’s swim lesson, so much so that another parent has to tell him to pay attention.

But first, they have to get to the opening date. In the exchange’s official home, on the first floor of the Rhode Island State House across the street from the dungeon, there’s a white dry-erase board hanging in the corner with “158 Days” written in blue marker. That’s the countdown to Oct. 1. When told it’s a little out of date (there are less than 140 days left), one staff member says: “Some days, we don’t change it. It’s too depressing.”

But they keep going, focused on the mission. The next day, the outdated figure is erased and replaced. “138 days” to go.

This story was originally written and published by Governing magazine. Photo from Shutterstock.

Utah’s Health Insurance Exchange in Limbo

Since the Affordable Care Act became law in 2010, states have known they would have a choice about whether to run their own health insurance exchanges or let the federal government do it for them. But with only eight months left before those online marketplaces are expected to open to the public, Utah hasn’t made up its mind.

Utah is one of several Republican-led states weighing an eleventh-hour decision about whether to set up a state-run exchange. But it is a special case because it is one of only two states, the other being Massachusetts, that already has a functioning insurance exchange. In both states, the exchange was the brainchild of a Republican governor eager to promote free market competition.  But once the concept became integral to the success of President Obama’s federal health law, Utah and many other Republican-dominated states resisted it.

The Obama administration has a strong interest in convincing red states to establish their own, tailor-made insurance exchanges keyed to their particular needs. To that end, the U.S. Department of Health and Human Services has vowed to give states as much leeway as possible. Utah is a test of that commitment.

As soon as the federal health law was enacted, Democratic governors jumped at the opportunity to set up their own exchanges, which are expected to serve 30 million Americans. Their states have received millions in federal grants to create the online marketplaces and call centers where individuals and small businesses will be able to choose between competing insurance plans that meet federal coverage standards.  Individuals also will be able to sign up for federal insurance premium tax credits and enroll in Medicaid through the exchanges.

GOP governors put off the decision on whether to launch state-run exchanges in hopes that either the Supreme Court would strike down the health law or Republican Mitt Romney — ironically, the Massachusetts governor who championed the exchange in that state — would become president and repeal it. Once those possibilities evaporated, most Republican governors decided to let Washington run their exchanges. A handful of states, some headed by Republicans and others by Democrats, elected to create joint state-federal exchanges.

Utah’s Republican Governor Gary Herbert asked Washington right after the elections to accept his existing state exchange as compliant with the federal health law — pretty much as is.  In response, Utah received “conditional” approval from the U.S. Department of Health and Human Services last week. But the conditions include changes to Utah’s exchange that state officials say the governor may not be prepared to make.

That leaves Utah’s decision about whether to run an exchange up in the air. But even if the governor were in full agreement with Washington, he would need final approval from the state legislature, which meets January 28.

So far, Utah lawmakers have been solidly against a state-run exchange. In fact, a law was enacted in 2010 preventing the state from seeking any federal money for the project.  And despite the governor’s recent request for the flexibility to convert its existing exchange into a health law-compliant exchange, many in the legislature still oppose the idea.

One influential lawmaker, however, has an alternative. Republican Representative Jim Dunnigan, the  chair of Utah’s Health System Reform Task Force, says it’s clear the federal government isn’t going to give Utah the leeway it needs to run its own exchange. Instead, the state should maintain its existing small business exchange and let the federal government build a new site for consumers.

One thing working in Utah’s favor, at least from Herbert’s point of view, is that the state’s existing exchange has been a success. It includes 140 health insurance plans and has sold coverage to 326 small businesses employing 7,890 individuals. The site uses what it calls a “defined contribution” approach that allows employers to decide how much they want to contribute to their employees’ health insurance and then select a list of policies employees can choose from.

Of the companies served by the exchange, 67 percent had no prior coverage for their employees, and 92 percent renewed their policies after the first year. The exchange is working with 789 insurance brokers across the state to expand the number of businesses it serves, according to the governor’s office.

But the site has its critics. Unlike the one in Massachusetts, the Utah exchange — now called Avenue H — does not vet insurance policies or negotiate for the lowest prices. Built in 2009, the website was designed to let all insurance carriers offer their policies to small businesses as a way to promote competition.

As a result, critics say, many small businesses that have visited the site find the policies too expensive and look elsewhere. Utah has about 60,000 businesses with fewer than 500 employees, according to the U.S. Small Business Administration. Covering 326 businesses after two years of operation is hardly an achievement, they add.

So far, Avenue H does not offer comparison shopping for individuals, but Herbert says the state always planned to extend the service to consumers. In fact, the plan also envisioned a tool that would allow people to pull together funding from various sources —which could include federal tax credits — to purchase their policies.

Since November, Herbert and the Obama administration have been swapping letters about whether Avenue H will pass muster under the health law.  If Washington agrees to approve Avenue H in its current form, Herbert has said he would join three other Republican-led states, Idaho, Nevada and New Mexico, in creating a state-run exchange.

“I want the Utah exchange to survive and thrive as we originally envisioned it,” Herbert wrote to President Obama ;ast month. “In fact, I hope it becomes a model for other states to use as a platform for their own versions regarding health care reform.” In subsequent letters, Herbert outlined his plans for expanding Avenue H to serve individuals and larger businesses.

HHS Secretary Kathleen Sebelius promptly replied to his letter, promising that her staff would work with the state to expand its existing exchange. Herbert thanked her, but made it clear what the state would and would not do to comply with the health law. Within days, Sebelius gave the Utah exchange a conditional stamp of approval. The state is expected to give HHS more details on its plans on February 1.

The problem for Utah is that the agency’s approval came with a long to-do list. “That wasn’t what we wanted to hear,” says the governor’s exchange chief, Patty Conner. “We wanted to hear that they would approve the exchange that we have. I think we have a different definition of flexible.”

Conner says she and her staff are committed to dramatically expanding Avenue H according to their own plans, not the check lists and timelines forwarded by HHS. She says she’s confident the site will be ready to receive consumers by October 1, and will provide most of the services outlined in the federal health law. She intends to use a seamless software patch to link Avenue H to federal premium credits and Medicaid forms.

Behind the scenes, officials in the governor’s office say they’re mystified by Washington’s approval letter. “Utah’s position on our state health exchange has not changed and it will not change,” wrote deputy staff chief Ally Isom in an official response. “Of course we’ll review the HHS announcement and determine if the conditions are acceptable or reasonable for our state exchange — and that includes sitting down with legislators — but there is nothing about Utah’s path that changes as a result of today’s announcement.”

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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