关键词： 美国 医疗改革
2012年12月24日讯 /生物谷BIOON/ --美国的18个州以及哥伦比亚特区将以州为单位开设独立的医疗保险交易所。
据了解美国公共与卫生服务部将12月14日定为美国各州是否加入这项计划的最后期限。随着期限的临近，仅有4个共和党执政的州、以及另外14个由民主党人执政或中立的州宣布参与这项计划。另外，希望与联邦政府合作管理医疗保险市场的州则应在13年2月15日前提交意向书与交易所的发展计划。
由于共和党对奥巴马的医疗系统改革法案持抵制态度，大多数共和党人都消极回应这一计划。但令人惊奇的是，由共和党控制的爱荷华州此次决定参与这项计划。该州州长认为由各州独自开设医疗保险交易所将比通过与联邦政府合作管理医疗保险市场更加经济。
华盛顿州的交易董事会成员Dr. Danielson私下称，这项医疗改革的推行将有助于人们选择最适合自己的医疗保险。（生物谷Bioon.com）
详细英文报道:
Washington As a mid-December deadline arrived for states to declare their intentions to pursue state-based health insurance exchanges, only four states led by Republican governors had decided to join the pack. In these states and the 14 states - plus the District of Columbia - with Democratic or Independent governors that decided to forge ahead on a state-based coverage marketplace model, the move had support from physicians who continue to strive for a voice in the exchange development process.
The Dept. of Health and Human Services recently gave more time for states with an interest in either the state-based or partnership exchange option to declare their intentions and submit blueprints. Dec. 14 was the deadline for states to declare and submit blueprints on state-based exchanges. Feb. 15, 2013, is the deadline for submitting letters of intention and blueprints on exchanges that will be operated under a federal-state partnership.
According to a list from the Dept. of Health and Human Services at this article's deadline, state-based exchanges will operate in 18 states and D.C. Nine of them already had received conditional approval from HHS for the exchange blueprints that they submitted.
Consultant Avalere Health LLC estimated that the states with their own insurance marketplaces would enroll only 2.8 million people out of the 8.2 million nationwide who are expected to obtain coverage through exchanges in 2014.
"I do think that there will be a number of states that … wish that they had been prepared and ready to do state-based exchanges. I wouldn't be surprised if there were still some ways for that to happen, even after the deadline," said Ben Danielson, MD, a pediatrician in Seattle. Washington is one of the nine states that had received conditional approval by HHS to operate a state-based exchange.
Utah, a pioneer in the exchange arena, also wants conditional status but must revise its blueprint first. Utah already operates an exchange that offers 140 health insurance plans to more than 7,600 individuals in small businesses throughout the state. To comply with the provisions of the Affordable Care Act, Utah's exchange would have to expand to include larger businesses and individuals, something the state plans to do in the near future, Republican Gov. Gary Herbert wrote in a recent letter to President Obama.
Additionally, the Utah exchange would need to include a mechanism to separate the individuals who qualify for Medicaid from the ones who would qualify for federal subsidies for private coverage on the exchange, said David Lind, president of employee benefits research firm David P. Lind Benchmark in Clive, Iowa.
In a Dec. 13 letter to the Utah governor, HHS Secretary Kathleen Sebelius said her department would work with the state in certifying the exchange, and that she supported the state's goals of expanding the current exchange's offerings beyond small businesses.
Lind said his home state of Iowa is pursuing a partnership exchange with the federal government, an option under which at least some control is deferred to federal officials. Cost concerns may prevent the state from doing a full state-based exchange right now, but once it works out some issues, "I wouldn't be surprised if Iowa reverts from a partnership to a state-based exchange" in a few years, Lind said.
Some surprises on the list
Most GOP governors have appeared resistant to their states forming their own exchanges in part due to their general opposition to the health system reform law. But in Idaho, Republican Gov. C.L. "Butch" Otter decided that it would be more prudent to operate a state-based exchange than have the federal government administer the marketplace, the outcome for any state that rejects the exchange concept.
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