Could the Obamacare marketplaces survive without Obamacare? Kevin Patterson, who runs Colorado’s state marketplace, thinks so.

Patterson is the chief executive of Connect for Health Colorado, and he knows that within a few weeks, Republicans will likely repeal the Affordable Care Act. Their repeal plans don’t typically include keeping the marketplaces that Obamacare set up, where people on the individual market can shop for and compare different health insurance plans.

But Patterson is working to change that. He is currently exploring how to keep an Obamacare marketplace open in a post-Obamacare era, continuing to use the technology the state built as a way to make shopping for insurance easier.

“We’re beginning to come up with some thoughts about what the market will look like post-ACA,” he says, adding that Coloradans “like the selection tools we have to support the assistance network that explains to people what those are.”

Patterson and I spoke earlier this week, when I was in Colorado to deliver a talk at the Colorado Health Institute’s winter conference. What follows is a transcript of our discussion, lightly edited for length and clarity.

Sarah Kliff

Can you start off talking about what the last month has been like for you as someone running an Obamacare marketplace? How are things different for you now than they were on November 7?

Kevin Patterson

That’s a big question.

We had been working on other lines of business to add to the tax credit. We were thinking about rounding out what we do. Let’s say a business comes through and says, “Can you do the whole package for me?” We can take that burden off them if they’re already coming to us for some of the shopping features.

Our messaging this year was really about, No matter what happens on Election Day, you’re going to need insurance for 2017. We didn’t talk much about the penalty; we didn’t talk much about the name of the program. We just talked about, You need to protect yourself. So that seems to be going really well; in November we were more than 20 percent ahead of last year.

Then there was that election thing. [laughs] Now the question is how do we pivot to whatever comes out of the Republicans, because you know it’s going to be something different. So what I’ve been doing is talking a lot with carriers, with providers, just everywhere around, to say, What are you guys thinking and what do you think makes sense in this new world?

A lot of people don’t know a lot. We spent a few days last week in DC with some other exchange directors, governor’s office staff, Medicaid directors, and it was interesting. It was a different kind of meeting then just exchange directors before.

Sarah Kliff

This is something that was planned before the election?

Kevin Patterson

Yes, it was, and then the agenda came out really, really late. And I’m sure they changed what they were thinking about. Now it’s a question of, What does the new world begin to look like? We’d done some preliminary work on a strategic plan. We’re saying we might need to think about what the new world looks like before we finish that effort. We’ve gone back and looked at our enabling legislation.

Should federal policy change, we’ll be ready to change. But we’ll be staying true to our commitment to accessibility, affordability, and choice. We’re going to have to turn on a dime and head toward this new policy. We don’t know yet. And going to DC told me we’re not the only ones who didn’t know.

Sarah Kliff

Before the election, what were the types of things you considered your biggest problems running an Obamacare marketplace?

Kevin Patterson

We were still working to explain what the Affordable Care Act really was and really wasn’t ... educating people around health insurance. We were working to more outreach so that people understood it. We were really going to work on this piece of it, but now we’re waiting to see.

Sarah Kliff

I shared in my talk earlier my thoughts about the repeal-and-delay strategy for Obamacare and why I don’t think it will work. Can you talk about how you think about it as a marketplace director? Are you hearing from carriers how they think about it? What would your marketplace be like in this two- or three-year transition period?

Kevin Patterson

We talk as marketplace directors about what we can do to keep them in but, if I’m a carrier, I don’t know how they make sense out of this. When an actuary doesn’t understand, or they don’t know something, it costs you more. I’m really concerned that rates that will be filed on the individual market and next year will be really, really high because there are so many questions. If there is a long delay, that’s the one thing I worry about the most.

Sarah Kliff

So do you think carriers will stay in the market but just charge more?

Kevin Patterson

I don’t know. My crystal ball fell off the table and is still in for repair. I just don’t know.

Sarah Kliff

If you were telling the Trump administration, “Here’s what we need to make a transition work,” what would you tell them? I’ve heard chatter about reestablishing some of the premium stabilization programs, ones that were meant to ensure that carriers wouldn’t lose too much money. Do you think that would work?

Kevin Patterson

That’s going to be tough. It’s tough to explain to customers why you are giving the insurance companies more money. So I think that’s a difficult sell to the public.

Sarah Kliff

What’s the stuff that keeps you up at night with the marketplace right now?

Kevin Patterson

Right now we just don’t know much, and the uncertainty is the toughest part. We knew what our challenges were under the Affordable Care Act; there were some tweaks that would have been part of the conversation. Now you don’t know what it is. We’re going to have to see what comes out of the discussions between the administration and Congress, and make some determinations of what we think really works well for Colorado.

Having a state-based marketplace with our own platform, we feel really good about that. I think some of my other colleagues who don’t own their platform or are on Healthcare.gov are a little more nervous than I am.

Sarah Kliff

What do you do in the next year? How do you plan for uncertainty?

Kevin Patterson

We’re spending a lot of time with folks at the state level, because I think there will be a lot more flexibility given to states to do some things. It doesn’t mean we’re not working with our congressional delegation; I’m talking to them so they know, Hey, we’re here, we can help you answer questions. But as far as the conversation inside the Beltway, we’re staying connected to it, but we’re spending a lot more time closer to home.

Sarah Kliff

So do you see a place for marketplaces in a post-ACA world?

Kevin Patterson

I think so. We’ve heard from plans and consumers how they don’t want to go back to the days of taking the certificate of benefits from each insurance company and laying it out to try to figure out how to shop. They like being able to come to one place, figure out where to go and what to pick. They like the selection tools we have to support the assistance network that explains to people what those are.

We’re beginning to come up with some thoughts about what the market will look like post-ACA, so we’ll be working with our board and stakeholders in laying out what we think some of those options are in a not-too-distant future.

Sarah Kliff

So if you ran a marketplace after the ACA, how would Colorado pay for it? Does it seem feasible to continue on this part of the health care law, a place to shop for plans and compare coverage, if the Republican replacement plan isn’t providing much funding or infrastructure for that?

Kevin Patterson

We can’t run all the numbers yet, because we don’t know who would sign up, but I think what we’re saying is there are certain aspects that we’re hearing in very Republican proposals that we could implement on our exchange. We’re trying to say, Here’s where we fit and here is some value we can add to the conversation. We’re not trying to say we’re folding up our tent and going home. We have some proactive things that we think can still help people, to still meet that mandate of access, choice, and affordability.

Sarah Kliff

When you’re meeting with other state marketplace directors, are you finding that other people want to keep running a marketplace in a post-ACA world, like you’re thinking about?

Kevin Patterson

It varies state by state, and varies dramatically. The politics of your state drives that. California, I think they’re thinking things that are very different than I’m thinking.

Watch: Repealing Obamacare could change millions of lives