A leading advocate of the federal law is urging the state to handle the other key exchange component: consumer engagement.
Perry Bryant, executive director of West Virginians for Affordable Health Care, believes the exchange's success rests on the state promoting the new marketplace and then helping people and small employers pick the best coverage.
"It's public education," Bryant said. "This is complicated stuff, with premiums and co-pays and deductibles, and some of these people may have never had insurance."
Bryant cited how well the state has enrolled those eligible for its Children's Health Insurance Program, which covers more than 25,100 youths. He contrasted that with the special insurance pool for people otherwise denied coverage because of pre-existing provisions. Washington runs that pool for the state, and Bryant estimated it has less than 150 enrollees.
"The federal government has done a miserable job," Bryant said. "Why would we want them to do the consumer engagement piece?"
Bryant agrees that West Virginia cannot run an exchange by itself, but also views that as a missed opportunity. The state could have pursued a federal grant to help it build and operate the marketplace, he noted. But time has run out. Exchanges must begin enrolling people for coverage next October, and the policies will take effect in January 2014.
At least some health insurers see value in a state-federal partnership, said Jane Cline, West Virginia's longtime former insurance commissioner. Her agency studied the exchange model before the federal overhaul, which passed in 2010 while Cline was president of the National Association of Insurance Commissioners.
"Some of the health insurers we work with believe that the federal government does have some offerings," said Cline, who is now public policy director for the Spilman, Thomas & Battle law firm. "I think it's prudent to evaluate all of the options, and that's what the governor appears to be doing."
Both Bryant and Cline credited Jeremiah Samples, an insurance commission official, with aiding that review. Among other tasks, Samples helped develop the enrollment and cost estimates. He's also held regular meetings with insurers, agents, medical providers and consumer advocates to keep them all in the loop."We're in a tough situation, because we're trying to convey, to tell our stakeholders information based on, really, assumptions about" the federal law, Samples said. "The burden, at this point, is on the federal government to get this information to states, and West Virginia is not unique in this."