A National Health Insurance Enrollment System? Maybe.

With 36 states utilizing Healthcare.gov, and with at least 2 additional states considering enrollment, the concept of a national healthcare insurance exchange (HIE) may quickly become a reality. This would be converse to the ideals behind the Affordable Care Act, which intended to have each state running its own independent HIE. Many remain worried as to whether the federal government is prepared for such an undertaking.

“We’re kind of, in a way, stumbling into this situation,” said health expert and former Deputy Secretary of HHS Tevi Troy.

The federal exchange option was originally meant to be a safety net for those states that did not build exchanges in time to meet consumer demand, but it is unlikely that many states would have predicted there would be so many challenges in establishing state-run exchanges.

“While [the administration] spent an inordinate amount of time and energy and money encouraging states to run and own their own exchanges, I think that that has kind of shifted,” said Jon Kingsdale, a consultant who worked with the original Massachusetts exchange under former Governor Mitt Romney.

Although CMS said it would continue to work with states in securing their exchanges, many have opted to use the federal exchange in order to resolve growing financial and logistical problems. This decision may eventually affect state legislators if they later change their mind.

“I think forces inside the federal government think the federal government should run this,” said Joel Ario, a consultant with Manatt Health Solutions. “I think those folks are now pushing hard, and if the states aren’t careful, there may be some … motion to make it harder for the states to reclaim their role.”

One solution may be choosing state-federal partnerships, where states could modify federal exchange offerings to suit their particular needs. Several states, including New Hampshire and Michigan, have already taken advantage of such an arrangement.

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