The exchanges cost $7.4 billion in federal dollars to set up. About $3.9 billion of that went to 15 marketplaces run by states and the District of Columbia, which all spent a lot more on outreach per enrollee than HealthCare.gov.
Now, an analysis of federal data from former Obama administration official Jay Angoff, now with law firm Mehri and Skalet, shows state-based exchanges spent more than twice as much per enrollee than the federal exchanges.
Price per enrollee varied dramatically from state to state. California, for instance, operated the cheapest state-run exchange at $758 per enrollee, which is still higher than the average for federal exchanges. Hawaii's state-run exchange, meanwhile, cost $23,899 per enrollee — well above the price for a full year of health insurance.
It's worth noting, however, that this analysis only counts federal funding to federal and state-run exchanges, which misses private outreach groups that, in general, spent much more on states with federal exchanges than states with state-run exchanges.
In some cases, the high price tag is a sign of a poorly run exchange. Hawaii's exchange, for example, both ran up costs and missed enrollment projections. So part of the problem was Hawaii had few enrollees relative to its large budget. But even if the state had hit its enrollment projections, its cost per enrollee would still be in the thousands.
Angoff's findings suggest that states like Hawaii, then, would be better off switching to the federal exchanges, if they can't get their costs under control.
Hat tip to Kaiser Health News for the analysis.