關(guān)鍵詞： 美國(guó) 醫(yī)療改革

2012年12月24日訊 /生物谷BIOON/ --美國(guó)的18個(gè)州以及哥倫比亞特區(qū)將以州為單位開設(shè)獨(dú)立的醫(yī)療保險(xiǎn)交易所,。

據(jù)了解美國(guó)公共與衛(wèi)生服務(wù)部將12月14日定為美國(guó)各州是否加入這項(xiàng)計(jì)劃的最后期限。隨著期限的臨近，僅有4個(gè)共和黨執(zhí)政的州,、以及另外14個(gè)由民主黨人執(zhí)政或中立的州宣布參與這項(xiàng)計(jì)劃。另外,，希望與聯(lián)邦政府合作管理醫(yī)療保險(xiǎn)市場(chǎng)的州則應(yīng)在13年2月15日前提交意向書與交易所的發(fā)展計(jì)劃,。

由于共和黨對(duì)奧巴馬的醫(yī)療系統(tǒng)改革法案持抵制態(tài)度，大多數(shù)共和黨人都消極回應(yīng)這一計(jì)劃,。但令人驚奇的是,，由共和黨控制的愛(ài)荷華州此次決定參與這項(xiàng)計(jì)劃。該州州長(zhǎng)認(rèn)為由各州獨(dú)自開設(shè)醫(yī)療保險(xiǎn)交易所將比通過(guò)與聯(lián)邦政府合作管理醫(yī)療保險(xiǎn)市場(chǎng)更加經(jīng)濟(jì),。

華盛頓州的交易董事會(huì)成員Dr. Danielson私下稱,，這項(xiàng)醫(yī)療改革的推行將有助于人們選擇最適合自己的醫(yī)療保險(xiǎn)。（生物谷Bioon.com）

詳細(xì)英文報(bào)道:

Washington As a mid-December deadline arrived for states to declare their intentions to pursue state-based health insurance exchanges, only four states led by Republican governors had decided to join the pack. In these states and the 14 states - plus the District of Columbia - with Democratic or Independent governors that decided to forge ahead on a state-based coverage marketplace model, the move had support from physicians who continue to strive for a voice in the exchange development process.

The Dept. of Health and Human Services recently gave more time for states with an interest in either the state-based or partnership exchange option to declare their intentions and submit blueprints. Dec. 14 was the deadline for states to declare and submit blueprints on state-based exchanges. Feb. 15, 2013, is the deadline for submitting letters of intention and blueprints on exchanges that will be operated under a federal-state partnership.

According to a list from the Dept. of Health and Human Services at this article's deadline, state-based exchanges will operate in 18 states and D.C. Nine of them already had received conditional approval from HHS for the exchange blueprints that they submitted.

Consultant Avalere Health LLC estimated that the states with their own insurance marketplaces would enroll only 2.8 million people out of the 8.2 million nationwide who are expected to obtain coverage through exchanges in 2014.

"I do think that there will be a number of states that … wish that they had been prepared and ready to do state-based exchanges. I wouldn't be surprised if there were still some ways for that to happen, even after the deadline," said Ben Danielson, MD, a pediatrician in Seattle. Washington is one of the nine states that had received conditional approval by HHS to operate a state-based exchange.

Utah, a pioneer in the exchange arena, also wants conditional status but must revise its blueprint first. Utah already operates an exchange that offers 140 health insurance plans to more than 7,600 individuals in small businesses throughout the state. To comply with the provisions of the Affordable Care Act, Utah's exchange would have to expand to include larger businesses and individuals, something the state plans to do in the near future, Republican Gov. Gary Herbert wrote in a recent letter to President Obama.

Additionally, the Utah exchange would need to include a mechanism to separate the individuals who qualify for Medicaid from the ones who would qualify for federal subsidies for private coverage on the exchange, said David Lind, president of employee benefits research firm David P. Lind Benchmark in Clive, Iowa.

In a Dec. 13 letter to the Utah governor, HHS Secretary Kathleen Sebelius said her department would work with the state in certifying the exchange, and that she supported the state's goals of expanding the current exchange's offerings beyond small businesses.

Lind said his home state of Iowa is pursuing a partnership exchange with the federal government, an option under which at least some control is deferred to federal officials. Cost concerns may prevent the state from doing a full state-based exchange right now, but once it works out some issues, "I wouldn't be surprised if Iowa reverts from a partnership to a state-based exchange" in a few years, Lind said.

Some surprises on the list

Most GOP governors have appeared resistant to their states forming their own exchanges in part due to their general opposition to the health system reform law. But in Idaho, Republican Gov. C.L. "Butch" Otter decided that it would be more prudent to operate a state-based exchange than have the federal government administer the marketplace, the outcome for any state that rejects the exchange concept.

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