Budget model uncertain for state health care exchanges

ST. PAUL, Minn. — The 14 states running their own health insurance marketplaces had all their startup costs footed by the federal government, but they’re supposed to pay for themselves starting next year under the federal health care reform law.

In several states, it’s not clear whether it will work out that way. Projected enrollments are lower than expected, meaning the insurance surcharges designed to sustain the exchanges might not generate enough revenue in the years ahead without significant changes in the financing model.