Apr. 29—Oregon officially dropped its state-run health insurance website in favor of a federally operated version used in 36 other states.

A state board voted unanimously on March 25 to turn over IT operations to the federal government after the enrollment site failed to sign up a single beneficiary for individual insurance coverage under of the Affordable Care Act (ACA), according to news reports. The state will technically continue to run its own marketplace, according to healthcare experts, although it is unclear what power Oregon officials will retain to regulate plans sold in the state through the federal website.

Oregon’s marketplace enrollment site was the worst, although several of the 14 others that are state run are seriously flawed. At least one other state—Maryland— has considered switching to federal control.

Many questions remain unanswered, including whether the insurers selling policies in Oregon will continue to do so next year and whether the 70,000 residents that were able to sign up through a cumbersome paper-based workaround will have to re-enroll next year.

The ACA encouraged all states to run their own marketplaces and provided extensive funding--$134 million in the case of Oregon—to help them do so.

Despite the problems encountered by Oregon and some of the other states operating their own marketplaces, several more states—including Idaho and New Mexico—reportedly are considering operating their own marketplaces. They have until June to obtain federal approval to operate their own exchanges.

Plan Subsidies Questioned

The number of enrollees in the ACA exchanges also could be influenced by the ongoing tussle over whether hospitals or others can help them afford their coverage.

The American Hospital Association and the Catholic Health Association of the United States on April 28 asked the U.S. Department of Health and Human Services to provide written clarification regarding whether hospital-affiliated or other charitable foundations are allowed to subsidize exchange plan premiums and cost sharing.

The Centers for Medicare & Medicaid Services issued a Q&A on Feb. 7 that stated that such subsidies were not discouraged, but in payment rules from March 14 urged insurers not to accept premium assistance from hospitals and other providers.

“Although HHS staff have told us that the rule did not represent a change in HHS’s position, our members and their legal advisors need an authoritative statement on which they can rely,” the organizations stated in a letter.

HFMA, with input from its members, also plans to issue a comment letter urging CMS to provide clarifying guidance on the recent rules.

Publication Date: Tuesday, April 29, 2014