The healthcare law envisioned most states setting up their own exchanges and authorized a federal fallback in states that didn’t. But Republican governors have largely resisted setting up their exchanges, forcing the federal government to step in.
Although many states have refused to set up their own exchanges, several states are willing to take over the marketplaces after the federal government builds them, Sebelius said.
“We are actually in conversations with lots of states” that could see themselves taking over their exchanges down the road, she said.
Although the healthcare law directed HHS to set up fallback exchanges, it did not provide any funding for the federal exchange. The department has scraped together funds from other areas and drawn from a $1 billion account set aside for general implementation of the healthcare law.
Sebelius noted that the Congressional Budget Office estimated the total cost of implementation at $10 billion. The HHS has done “an extraordinary job” stretching its resources, she said.
“I think the good news is we’re well under what the budget estimates were,” Sebelius said.
The HHS budget request sought $1.5 billion for the federal exchange, but Congress is unlikely to provide that money.
Department officials have been vague about the consequences of not receiving the additional funding.
Sebelius said Friday that the $1.5 billion would help her department with information technology projects, including the data hub that exchanges will use to retrieve information from other state and federal agencies
“That’s really to get the IT hub, the call center, the IT up and running,” she said.
But later in the same series of questions, Sebelius said the data hub is nearly finished.
“The hub is basically built and paid for,” she said.