The Robert Wood Johnson Foundation (RWJF) recently released four reports jointly prepared by the Urban Institute and the Center on Health Insurance Reforms (CHIR). The reports track health reform implementation in ten states: Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island, and Virginia. The latest reports focus on early market reforms, state insurance exchange development, insurance rate review, and plan participation and competition within the exchange.
The first brief reports that early insurance market reforms are being implemented in all 10 states with the encouragement and efforts of state officials, insurers, and consumer advocates. The second report found that although exchange implementation progress varies widely across the states, many advocates, policymakers, and stakeholders have been highly involved in the process. The third brief found that most states seem to view the Affordable Care Act’s (ACA’s) insurance rate review provisions as an opportunity to foster accountability for insurers and educate consumers regarding rate increases. The fourth brief reports that markets with a dominant insurer or hospital are less likely to see augmented plan competition under the ACA. However, those without such a dominant plan will likely see increased competition, which could thus lead to lower-premium plan offerings.
August 2, 2012
Previous updates have summarized
final IRS regulations implementing provisions of the Affordable Care Act that provide premium tax credits to help low- and moderate-income individuals and families buy affordable health insurance through State health insurance Exchanges. The IRS regulations provide that premium assistance tax credits are available to all eligible state residents, regardless of whether their state Exchange is state-operated or federally facilitated. This Update examines a dispute that that has arisen regarding the availability of premium assistance tax credits in federally facilitated state Exchanges.
May 25, 2012
On May 16, 2012, the United States Department of Health and Human Services issued a Draft Blueprint for Approval of Affordable State-based Exchanges (SBEs) and State Partnership Exchanges (SPEs). HHS also issued General Guidance on Federally Facilitated Exchanges (FFEs). Together, these two documents provide additional implementation information related to the final Exchange regulations issued by HHS on March 27, 2012, (click here for the regulations) which broadly describe the structural and operational requirements for state Exchanges, specify the Exchange approval process, and provide for FFEs in states that do not elect to operate a state Exchange. The newest guidance amplifies on the approval process for both state-based Exchanges (SBEs) and state Partnership Exchanges (SPEs) as a sub-class of FFEs but with...
April 10, 2012
The Department of Health and Human Services (HHS), Center for Medicare and Medicaid Services (CMS) has issued a final rule
addressing two previous proposed rules: “Establishment of Exchanges and Qualified Health Plans”
and “Exchange Functions in the Individual Market: Eligibility Determinations and Exchange Standards for Employers.”
The final rule addresses 1) minimum federal standards that States must meet to establish and operate exchanges, 2) the minimum standards that health insurance issuers must meet as Qualified Health Plans (QHPs), and 3) basic standards employers must meet to participate in the Small Business Health Options Program (SHOP) Exchange. CMS indicates that certain portions of the rule will be considered interim final, and the agency will accept comments on certain sections.
CMS also indicates in the Preamble that additional details will be made available in future guidance and rulemaking, where appropriate. For information on the proposed rules, click here
. This Update describes major changes made by CMS in the final rule.
September 1, 2011
This Update to the health insurance Exchange Implementation Brief examines a proposed regulation issued on August 17, 2011 as part of three proposed rules to implement provisions of the Affordable Care Act related to health insurance affordability. Companion Updates explain the proposed Medicaid eligibility rule and the proposed rule related to health insurance premium tax credits; this Update focuses on Exchange functions related to determinations of eligibility for “Exchange participation and insurance affordability programs,” as well as standards for employer participation.