Most of the 13 state-run public health insurance have collectively spent $4.8 billion in federal funding during their first 17 months of operations and face serious cash-flow problems, according to a website named after the late conservative commentator Andrew Breitbart.

And with major insurance carriers seeking HIX premium increases of up to 51% in some states, the report suggested marketplace mergers as one political solution. It noted that both Covered California and Vermont Health Connect significantly overestimated enrollment and now must slash advertising, outreach and technology services.

Also see: HIX enrollment numbers vary based on definition of exchange

Other troubled state HIXs mentioned on Breitbart.com included the much-maligned Cover Oregon, whose lawsuit against its technology contractor Oracle has made headlines, Nevada’s Silver State Health Insurance Exchange, which survived campaigns to disband the HIX, and Hawaii Health Connector, described as “nearing a shutdown after the state legislature rejected an emergency $10 million funding request.”

However, several of these exchanges denied merger talks or emphasized improvements for the next enrollment season. Roy Kennedy, a spokesman with Covered California, says there’s no such plan to join forces with other financially strapped exchanges – adding that occasionally it will participate in conference calls with other state HIX leaders to share benchmarking strategies. Covered California ran a nearly $80 million deficit for its 2015-2016 fiscal year just a few months ago.

Also see: Private exchanges: Not right for everyone

Oregon’s health insurance marketplace is transitioning from Cover Oregon to the Department of Consumer and Business Services July 1, according to Lisa Morawski, a spokeswoman with the department. “Although Oregon uses the Healthcare.gov website for enrollment, we are responsible for all other aspects of our state-based marketplace,” she explains, adding that there are no plans to merge with another state-based marketplace. Oracle has counter-sued Cover Oregon, claiming it is still owed $23 million.

Following several failed legislative attempts to dissolve the Silver State Health Insurance Exchange in Nevada, changes have since been made to improve enrollment and customer service for Nevadans. That effort includes a pre-screening tool to help determine what types of coverage state residents may be eligible for, as well as a link to either Healthcare.gov to find a qualified health plan or Access Nevada for Medicaid and Nevada Check Up, which also known as Nevada’s Children Health Insurance Program.

Also see: Nevada considers transitioning to Healthcare.gov

Nevada Health Link recently made the transition from a stand-alone, state-run HIX to a “supported state-based marketplace” through which back-end eligibility and enrollment functions are now provided by Healthcare.gov, reports Janel Davis, a spokesman with the exchange.

“This new path to enrollment has proven to be more reliable and allows Nevada Health Link to focus its efforts on consumer advocacy and assistance,” she explains. “One of the primary examples of this is the acquisition of operations of the Nevada Health Link call center from our previous contractor, bringing it in house with the help of our partners, the Nevada Primary Care Assocation.

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