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Gear up for HIX opportunities post Supreme Court ruling!

As per the provisions of Patient Protection and Affordable Care Act (ACA), States are expected to have Health Insurances Exchanges (HIX) up and running by Jan 2014. The Department of Health and Human Services (HHS) has awarded hundreds of millions of dollars to states to help them set up their exchanges, and will be doing so through 2014.

However, many states decided to pause planning for their insurance exchange in anticipation of the Supreme Court ruling on ACA. Some states viewed the Act as unconstitutional e.g. Alaska, Iowa and Wyoming found health care reform law unconstitutional, though believed an insurance exchange system was a viable solution for the uninsured. Some other states were least convinced of the ACA - Texas, Maine, and South Carolina have made very low progress on setting up a benefit exchange. Through its Jun 2012 ruling, Supreme Court made it clear that citizens are not necessarily being forced to purchase health insurance, but they are merely encouraged. The provisions of the individual mandate are being treated as a "tax", rather than a "penalty" and the Court confirmed the validity under Congress' constitutional authority.

The Supreme Court ruling forces States to formulate strategies to set up exchanges within the timelines. Interestingly, in States like Alabama and Arizona, where the Governors oppose provisions of ACA strongly, initiatives for setting up State level exchanges are progressing. States are expected to submit letters of intent or blueprints - that confirm their intent to run a state-based or partnership exchange - to Center for Consumer Information and Insurance Oversight (CCIIO) no later than 30 days prior to the required approval date of Jan 1, 2013, for plan year 2014. Hawaii is the first State to submit a letter of intent to have an insurance exchange up and running by the deadline.

Adopting the right procurement strategies to comply with the short timeline is a significant challenge in front of the States. Some States take up special procurement strategies to meet the deadlines set by the Early Innovator Grant. For example, Oregon State released a solicitation on May 23, 2011, and closed the special procurement on May 30, 2011. Other strategies may include States adding insurance exchange components onto existing contracts, such as for eligibility systems. Another technique States may choose to use is procuring for multiple components of the exchange under the same contract, such as call center and program integration services.

Post Supreme Court ruling, many of the States that were on a wait-and-watch mode, will most probably move forward with releasing solicitations for actual system implementation. Those states that have been sluggish will need assistance in performing gap analyses of their as-is and to-be technology environment. There will be an increasing need of consultative services for exchange implementation in the short term, and vendors should be ready with the right approach and strategy to address requirements quickly and effectively.

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