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Implementing the Affordable Care Act: State-Based Health Insurance Marketplaces
National Health Policy Forum March 1, 2013
Exchange + Outside
Marketplace Employer Coverage
Public Programs (Medicare, Medicaid/
CHIP)
Moving to 2014: A System of Coverage
State-Based Health Insurance Marketplaces
What is an “Exchange” (aka Marketplace)?
•Organized marketplace
•Available to individuals and small businesses
•State-based
•Enrollment begins October 1, 2013
Key Initial Decisions for States
•State-run vs. Federally Facilitated vs. Partnership?
•If Partnership, Plan Management and/or Consumer Assistance? •If FFE, Collaborate on Plan Oversight?
•If State-based….
Critical Decisions for State-Based Marketplaces
Initial Establishment of
Health Insurance Marketplaces
• Seventeen states plus DC chose state-based exchange*
• 7 states chose state partnership
• 26 defaulted to federally facilitated exchange
• State decisions likely to be fluid post-2014
*Mississippi’s application was rejected due to lack of support from the state’s Governor.
Initial Establishment of Health Insurance Marketplaces, as of February 15, 2013
Critical Structural and Operational Decisions for Marketplaces
• Structural and Operational Basics • Exchange establishment & authority
• Administration & governance
• SHOP structure and function
• Core Exchange Operations • Eligibility and enrollment
• Plan management
• Consumer assistance
• Financial management
Cross-Cutting Functional Decisions for Marketplaces
• Measures to reduce adverse selection
• Measures to maximize participation
• Measures to drive quality and delivery system reforms
• Oversight and monitoring measures
• Alignment and integration measures
State Exchange Decisions: Part of a Broader Context
Early Market Reforms
EHB 2014 Market
Reforms HIX Medicaid Expansion
AR Guidance Yes Some FFE-P Yes
CA Some Yes Some SBE Yes
CT All Yes All SBE Yes
DC Some Yes No SBE Yes
MT Form Review Default No FFE Yes
NY All Yes Some SBE Likely Yes
RI Form Review Yes Some SBE Yes
TX Guidance Default No FFE No
VA All Default No FFE ?
WA Some Yes Some SBE Yes
WV Form Review Default No FFE-P ?
Exchanges: A Means to an End
• Characteristics of a Better Health System • Improved Access
• More Affordable Coverage
• Improved Adequacy of Coverage
• Greater Value
• More Accountability
How will the new marketplaces advance these goals?
Thank you!
Sabrina Corlette, JD Research Professor [email protected] 202-687-3003