State-based exchanges will improve access to affordable healthcare insurance during 2023 open enrollment

This holiday shopping season, there's an important purchase that millions of Americans will make — health insurance. In most states, including Nevada, Open Enrollment Period (OEP) runs from November 1 to January 15. Last year, more than 100,000 Nevadans enrolled in health insurance plans on Nevada Health Link — a record number of enrollments for the state.

Enrollment levels were increased because of the Inflation Reduction Act (IRA) subsidies that made health insurance premiums more affordable, but equally as influential is the Nevada state-based exchange (SBE), Nevada Health Link. States with an SBE offer both the state and consumers distinct advantages, including flexibility, affordability, and autonomy, as well as access to critical data that make marketing campaigns more impactful. Nevada made the switch in 2019, a transition I was proud to be a part of as then executive director of Nevada Health Link.

States that run their own SBE have far more flexibility to execute on policy and programmatic goals than those on the federal marketplace. For example, SBE states can create programs which address the unique needs of their residents rather than being rigidly confined to the federal government's policies. SBE states can also set their own user fees and the rules around any special and annual enrollment periods. This flexibility also allows for SBEs to be quicker and nimbler when implementing policies that respond to federal changes (like the ARPA subsidies).

SBE states are also able to operate at a lower cost than Healthcare.gov, which charges operating fees to states. These fees are inevitably passed along in the form of higher premiums to federal marketplace consumers. States with SBEs can set their own user fee to insurers, helping to lower those premiums. In addition, health care marketplace technology and software have evolved over the years — and become less-costly — which has enabled states to become more efficient with their spending.

Look no further than Nevada as an example. The migration to a new website for consumers to shop and compare plans saved the state approximately $4 million in Fiscal Year 2021 alone.

Additionally, by accessing and utilizing data only provided through state-based exchange platforms, Nevada was able to deploy targeted messaging to harder to reach populations and partner with navigator entities to drive awareness of both the enrollment period and the availability of the subsidies. This resulted in a 21.5 percent increase in enrollment from 2019 to 2022, according to Kaiser Family Foundation. States operating on the federal platform find it difficult, if not impossible, to implement targeted marketing campaigns due to the lack of meaningful and time sensitive data from the FFM that is so often the backbone of impactful campaigns.

This year, Nevada will continue to leverage enrollment and market data to reach the 10.6 percent of Nevadans who are uninsured, buoyed by the many advantages that a SBE brings to the table. Ensuring that people have and keep health insurance is good for the economy and for the health and well-being of our families, friends, and communities.

Much has changed in the health care policy landscape since the start of the pandemic. But one thing is for certain during this Open Enrollment Period — states know their constituents best, and an SBE helps residents gain access to affordable health care coverage.

Heather Korbulic is the senior policy and strategy lead at GetInsured, where she engages local, state, and federal health care policy leaders in developing strategies for technology-driven improvements to the provision of health care and other public benefits. She was previously the executive director of Nevada's health insurance marketplace, the Silver State Health Insurance Exchange.

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