The Real Story: Advocates’ work in 2012 prepares states for consumer friendly Exchanges

We’ve all heard the prevailing story – state action to create health insurance Exchanges, online marketplaces where people can get information about and obtain health insurance, has been very limited in 2012. After eleven states and DC passed legislation to create Exchanges in 2011, we’ve seen an apparent slowing in state Exchange activity in the past year. No new legislation was adopted, but New York and Kentucky created Exchanges by executive order. However, our new report shows how state consumer advocates’ work in 2012 made significant progress in building a foundation for Exchanges going forward.

Although on the surface states appear to be deadlocked in building Exchanges, consumer advocates across the country have played important roles in design decisions in their states. There are many engagement points besides passing legislation that are critical to Exchange implementation, including building consumer expertise, working with other stakeholders, and framing the debate by educating policymakers, the media and consumers about consumer-friendly Exchanges. And many state consumer advocates have been engaged in these activities. A few examples:

• • In New York, advocates’ work to build relationships with Governor Cuomo’s staff and other key policymakers strengthened a campaign that led to an Executive Order establishing the New York Exchange in the State Department of Health.
• • In Alabama, advocates’ policy expertise improved the consumer-friendliness of an Exchange bill. As a result, the final version of the bill, which passed in the House, required consumer representation on the Exchange board and prevented conflicts of interest. Though the bill died in the Senate, Alabama advocates educated policymakers and state officials, and positioned themselves as they move into the next phase of Exchange implementation.
• • Advocates in Ohio were able to shape the public debate by working with the media on Exchange issues. This outreach resulted in timely and effective articles responding to misleading claims by some politicians and industry lobbyists.

Moving Forward Despite Roadblocks highlights the impact of well-organized and knowledgeable state consumer advocates in shaping consumer-oriented Exchanges, even in difficult political environments. Advocacy efforts in 2012 made a difference, providing lessons for others, laying the groundwork for the future, and moving Affordable Care Act implementation forward.

-- Quynh Chi Nguyen, Program and Policy Associate & Christine Barber, Senior Policy Analyst