Healthcare According To Ernie – Federally Facilitated Marketplaces, the total so far…


Two places I like to go periodically to check up on what’s happening in the world of public insurance exchanges are and  State Reforum has a number of really nice charts and graphs and they do a pretty good job updating all the information contained therein.  With all the news recently about various federal courts ruling for and against subsidies being eligible in the Federally Facilitated Marketplaces (FFMs) I thought it might be fun to call out how much we as a nation have spent so far on public exchanges.


Yes, five billion dollars with a B.  This number comes courtesy of the Kaiser Family Foundation and is the total of all grants provided to all 50 states.  To be completely transparent, these monies were provided in a series of grants defined by KFF as follows:

Planning Grants: These grants of up to $1 million each provided states with resources to conduct the research and planning for a Health Insurance Marketplace (also called Exchange) and determine how their Marketplaces will be operated and governed.

Level One Establishment Grants: These grants provide up to one year of funding to states for activities related to the development and implementation of State-based Marketplaces. States may apply for mulitple level one establishment grants.

Level Two Establishment Grants: This category of grants is designed to provide funding through December 31, 2014 to states that are further along in the establishment of a Marketplace. In applying for level two establishment grants, states must meet specific eligibility criteria, including that the state has: legal authority to establish and operate a Marketplace that complies with Federal requirements available at the time of the application; a governance structure for the Marketplace; a budget and initial plan for financial sustainability by 2015; a plan outlining steps to prevent fraud, waste, and abuse; and a plan describing how consumer assistance capacity in the state will be created, continued, and/or expanded, including provision for a call center.

Early Innovator Grants: These two-year grants were awarded to states to design and implement the Information Technology (IT) infrastructure needed to operate a Health Insurance Marketplace.

So where did all the money go?  Let’s take a look – I played with a couple tools (I used a trial version of Tableau for Mac for this one) to visualize data and I thought this one turned out pretty cool.

Total Grants by State

This plot shows all 50 states (sorry some are too small to display their names) in a condensed bubble plot by relative size of grants.  Not a big surprise, California comes out on top with a little more then $1B.  For those that are really curious, I’ve also included the table of data.

Grants by State Data

Since this post falls under the category of “Things that make you go hmmmmm” I’ll leave you with this thought.  If we invested $5B into the private sector to build marketplace solutions, where do you think we would be?