Commonwealth paper examines Exchanges, discusses challenges
Posted on October 1, 2010 | No Comments
A new paper by Professor Timothy Jost and funded by the Commonwealth Fund examines health insurance exchanges and offers insight into 8 difficult issues that face Exchanges.
May 17, 2013
The Center for Consumer Information and Insurance Oversight (CCIIO), a division of the Centers for Medicare and Medicaid Services (CMS), recently posted new guidance concerning federally-facilitated and state-based Exchanges (Marketplaces) established under the Affordable Care Act (ACA). The guidance purports that if states do not adhere to and enforce the requisite standards for health insurance issuers in federally-facilitated Exchanges, then CMS intends to coerce enforcement through civil penalties and plan decertification. CMS does not believe that decertification will be a common occurrence. In addition, the guidance stated that qualified health plans (QHP) paired with health savings accounts (HSA) must meet the cost-sharing reduction standards that apply to low income-individuals. CCIIO published additional guidance that expands upon which activities, in both federally-facilitated and state-based Marketplaces, that qualify for grant funding under ACA Section 1311. For instance, state-based Marketplaces are not permitted to use this funding for navigator outreach and education, yet they are allowed to use Section 1311 funds for "in-person assistance programs."
November 30, 2012
The Centers for Medicare and Medicaid Services (CMS) today released a proposed rule on benefits and payment under the Affordable Care Act (ACA). The proposed rule outlines how CMS plans to run federal exchanges and suggests how risk adjustment data should be collected. The rule also lays out the three-year transitional program that the federal government will run to maintain premium costs in the individual market, and projected that premiums will be 10 to 15 percent lower than they would have been without the reinsurance program. With regard to the reinsurance program, CMS said that federal exchanges can impose a user fee on health plans to finance the exchanges. However, to prevent the user fees from making the health plans less attractive, CMS is asking the Office of Management and Budget (OMB) to exempt the requirement that those fees cover the whole cost in 2014. Before 2014, it wants to cap the monthly fee rate at "3.5 percent of the monthly premium charged by the issuer for a particular policy under the plan." The goal of the rule is to stabilize the new exchange market, limit risk, and smooth over the transition. Comments on HHS’s proposed rule are due December 31.
November 16, 2012
Late yesterday, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius extended the deadline for states to decide whether to run their own exchange until December 14, 2012. The Republican Governors Association (RGA) sent a letter requesting the extension to Sebelius on Wednesday November 14, 2012, just two days prior to the initial deadline. This is the second time in a week that the Secretary has made extensions to key Exchange deadlines, having also recently extended the deadline to submit the state-run exchange blueprint paperwork (also December 14, 2012) and the deadline of whether a state will choose to partner with the federal government on their exchange (February 15, 2013).
November 9, 2012
U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today extended the deadline for states to submit Exchange Blueprint documents, until December 14, 2012. States must still notify HHS of their intent to pursue a state-run exchange by November 16, 2012, but now have an additional month to formally submit the Blueprint. Additionally, the deadline for states to decide on whether to pursue a state-federal partnership Exchange has been extended until February 15, 2013, a full three months beyond the original November 16, 2012 deadline. This decision by HHS should allow states more time to make crucial post-election decisions as to what kind of Exchange they intend to pursue, as well as allow the Administration more time to issue key regulations.
August 14, 2012
Today, the Office of Consumer Information and Insurance Oversight, a division within the Centers for Medicare & Medicaid Services (CMS), released the final version of the approval for state-based health insurance Exchanges. An Exchange is an entity that both facilitates the purchase of Qualified Health Plans (QHP) by qualified individuals and provides for the establishment of a Small Business Health Options Program (SHOP), consistent with provisions under the Affordable Care Act (ACA). Exchanges will provide competitive marketplaces for individuals and small employers to directly compare and purchase private health insurance options based on price, quality, and other factors.
June 29, 2012
U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced today a new funding opportunity to help states continue to implement the Affordable Care Act (ACA). When the ACA is full implemented in 2014, the Exchanges will provide individuals and small businesses with a one-stop shop to find, compare, and purchase quality, affordable health insurance. HHS also issued further guidance today to help states understand the full scope of activities that can be funded under the available grants. The funding opportunity announced today will provide states with 10 additional opportunities to apply for funding to establish a state-based exchange, state partnership exchange, or to prepare state systems for a federally facilitated exchange. To date, 34 states and the District of Columbia have received approximately $850 million in Exchange Establishment Level One and Level Two cooperative agreements to fund their progress toward building exchanges.
December 5, 2012
Beginning January 1, 2014, millions of previously uninsured individuals will gain access to health insurance coverage under the Affordable Care Act (ACA). On November 20, 2012, the Obama Administration proposed a series of regulations that move the nation significantly toward full implementation. These proposed rules will be analyzed at greater length in coming GPS Implementation Brief updates. In the meantime, this overview summarizes the major federal implementation matters that the Administration has recently released or is expected to address in policy or program implementation in the coming weeks and months as the 2014 full implementation date approaches. Together, these matters address...
October 15, 2012
A report released last week by the Congressional Research Service (CRS) examines the Health Insurance Exchanges under the Affordable Care Act (ACA). The CRS report outlines the required minimum functions of exchanges, and explains how exchanges are expected to be established and administered under ACA. The coverage offered through exchanges is discussed, and the report concludes with a discussion of how exchanges will interact with selected other ACA provisions.
October 4, 2012
A report recently published by Price Waterhouse Cooper (PWC) examines states' progress on exchange establishment. The report found that the country, on the whole, is lagging. Only 13 states have decided to create exchanges, while eight have indicated that they will let the federal government take control of exchange establishment. The majority, the report says, are still undecided, and have until November 15 to make a final decision. The PWC report also details typical exchange participants. On average, they are 33 years old, unlikely to have a college degree, and under 200 percent of the federal poverty limit.
July 26, 2012
Health insurance exchanges form the backbone of the private insurance reforms called for in the Affordable Care Act (ACA), as they will create a marketplace in each state for small employers and individuals without job-based health insurance to buy comprehensive health coverage, with premium subsidies available for those with low or moderate incomes. As of May 2012, 13 states, together with the District of Columbia, had taken legal action to establish exchanges, through legislation or executive order. State implementing laws are essential to the translation of broad federal policies into specific state and market practices. Overall, the laws in the 14 jurisdictions vary, but they tend to show a common approach of according exchanges much flexibility in how they will operate and what standards they will apply to the insurance products sold. In all states, these "threshold policies" will be followed by policy decisions, expressed through regulations, guidelines, and health plan contracting and performance standards. A new Commonwealth Fund issue brief analyzes the choices being made by the jurisdictions to begin establishing exchanges.