State Insurance Exchanges Are The Wrong Idea

(Disclaimer: I work in IT for a large healthcare company. These opinions are entirely my own, however.)

The Affordable Care Act (ACA, aka Obamacare) envisioned each state setting up its own insurance exchange. There was surprise when many states declined to do so. In the states that did so, the path to full administrative functionality is sometimes slow in the making. There's a really obvious question to be asked, and it feels like nobody is asking it. That question is--Why? Why would anyone ever think it makes sense for each state create its own Exchange??

Each state Exchange entails specifying, designing, coding testing and maintaining a major, complex, integrated information system. Why do the same thing 50 separate times? This is exactly the opposite of the logic that drives many corporate mergers, where the goal is to gain operational efficiencies by eliminating redundant, back-office functions. So why for the love of Pete is the blueprint for ACA that each state should do its own thing?!

There is an answer, and it lies in politics and the misguided perception that conditions vary so widely from state to state that each state that will be much better able to serve its local peculiarities (see previous post for more on this notion). In a modern, connected, transient homogeneous country, this is hogwash.

I really wish some of the national press would start asking this question. The business press, in particular, should be all over it.

UPDATE: This King vs Burwell article from NYT hints at it.