According to the report, the federal exchange cost an average of $647 per person that signed up, compared to $1,503 per enrollee in the 15 state-run exchanges. Even California, the state with the lowest per-enrollee cost, came in at $758 – higher than the federally-facilitated exchange. On the other end of the spectrum, the analysis estimated that Hawaii’s costs topped out at nearly $24,000 per enrollee followed by DC at $12,467. The report notes that their small population sizes mean fixed costs are associated with setting up an exchange are distributed over a smaller base of folks to be reached. The analysis certainly suggests that large operations like the federal government and California are able to achieve money-saving operations of scale.
You might be tempted to point out that healthcare.gov’s performance wasn’t exactly without its woes. Sure enough, but many states have had their own and, in some cases, even more debilitating challenges in operating their own marketplaces (a topic we wrote about here). In fact, the report suggests that perhaps those states still facing these challenges should give up and take the federal government up on its offer to run it for them — a move Oregon has already taken.
In the coming months, we’ll see if any other states decide to jump ship.