There
is just one federal health law, but the way Americans experience the
debut of its main provisions on Oct. 1 will vary widely depending on
where they live.
Every state, whether it supports the
law or not, will have a health-insurance exchange where people will shop
for coverage—the health overhaul's centerpiece.
"Your prices, your consumer experience
will differ dramatically across states or even regions in states," said
Joel Ario, managing director at Manatt Health Solutions, a New
York-based health-care consulting practice. Rural areas will likely have
fewer insurer choices than urban areas, where insurers are competing
more vigorously for new customers.
The divergences could make it harder to judge the law's success, at least initially. With the health law, President Barack Obama
envisioned expanding medical coverage for most of the 48 million people
who currently don't have it and placed confidence in governments to run
the system smoothly. Critics called his plan a government takeover of
health care that would result in bureaucracy run amok and higher costs.
After coverage begins Jan. 1, gauging which of those scenarios will be
closer to the truth could vary depending on the conditions in each area.
In general, the states that declined
to run their own exchanges are the ones where conservative legislators
and voters have been most hostile to "Obamacare." Many of those states
also have had historically tight eligibility for Medicaid and are
generally declining to expand it now. And they are also the states most
likely to have added restrictions on navigators.
Not all the differences fall along a
red state-blue state divide. Both Kentucky and Missouri voted against
Mr. Obama, but Kentucky is running its own exchange and using state
employees to encourage enrollment, while Missouri is relying on the
federal government's exchange and barring state employees from helping.
The price of insurance policies
available on the exchanges varies by area—and just as importantly, the
perception of the prices is likely to be different. Some states have
long had tight restrictions on the kind of policies that can be sold to
individuals and small businesses, resulting in relatively higher prices.
People in those states aren't likely to see big premium jumps. In
states that left insurers with a freer hand, some people face greater
price increases.
In Atlanta, before Georgia's new
federally run health exchange kicks off, the cheapest plan available now
has a monthly base rate of $43 for a healthy 30-year-old male
nonsmoker, reflecting the state's light regulation. The median plan
starts at $108 a month, according to a federal database of plans. Next
year, that same customer will likely have to pay at least $188 a month,
although some lower-income people could get subsidies toward premium
costs.
Under the new system, insurers must
accept all comers and can't charge sick people more. Currently, insurers
in some states are allowed to offer healthy people skimpy plans with
low rates, but those will go away when new federal requirements kick in
this fall.
"I was always skeptical of Obamacare,"
Georgia Insurance Commissioner Ralph Hudgens, a Republican, said in a
statement. "But I never imagined that it would lead to rates being
doubled or tripled. Increases of this magnitude will make coverage less
affordable and increase the number of uninsured in Georgia." Nationwide,
people who forgo coverage next year face a fine of at least $95.
By contrast, health insurance has long
cost more in New York, in part because the state has barred insurers
from rejecting customers over pre-existing conditions. In the new health
exchanges, the lowest-cost plan for a person living in Albany,
regardless of age or tobacco usage, will be $237 a month, according to
the state insurance regulator.
"These plans and rates deliver on the
promise that the exchange will offer quality health insurance coverage
at a price that works for New Yorkers," said the executive director of
the New York Health Benefit Exchange, Donna Frescatore, who was
appointed by Democratic Gov. Andrew Cuomo.
Write to Amy Schatz at Amy.Schatz@wsj.com and Louise Radnofsky at louise.radnofsky@wsj.com
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