Hugh Straley, formerly of Group Health, sent us this article this am from the New England Journal of Medicine.  He said it was worth a read, and we agree.  It provides a smart look ahead to 2012.

To summarize, the article says there are four key elements to watch this year:  state legislative sessions, the deadline for state grant applications for exchange funding, the Supreme Court case, and the federal elections.

While the last two are no brainers, the article makes some very good points about the first two.  On the state legislative sessions, the conclusion one must draw is that it is very likely, due to potential inaction by a number of states, that the federal government will ultimately be running a series of exchanges across the country.

The vast majority of state legislative activity will take place between January and June. At least 40 states are scheduled to start their 2012 sessions by mid-February. Nearly 75% will have sessions lasting less than 6 months, more than a dozen will meet for less than 3 months, and four are not scheduled to meet at all. The timing of the state legislative sessions is particularly important given the timing of the second event, the Supreme Court ruling on the constitutionality of the ACA, which is expected to be issued by the end of June. Given that only nine states have sessions running into July, waiting until the end of June to see how the Court rules would be a risky strategy for many states, which may by default cede control of key elements to the federal government.

This scenario, a default cessation of control by states to the federal government on key elements of the exchange, will grow increasingly likely over time.  The Republican primaries could drive up rhetoric against implementation at the state level.  And, the “air war” of a national campaign strategy is often played out “on the ground” among state and local officials.  In other words, if Republican candidates for office increasingly focus on repeal of the ACA, that could increase the likelihood of stalling among Republican-controlled legislatures.

That isn’t going to be the case in Washington State however, and this brings us an important note about the article’s second noteworthy point:  watch the exchange application process.  Washington State is well underway for planning this grant application, with the most recent example being HB 2319 released yesterday.  This is the state’s comprehensive bill on the exchange for 2012.  We were knee deep in it yesterday, as I’m sure many insiders were as well.  In short, and assuming passage, Washington appears well placed to receive additional money to implement an exchange here, regardless of what happens in the Supreme Court.