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Health Insurance Exchanges Under the Patient Protection and Affordable Care Act (ACA)
The fundamental purpose of a health insurance exchange is to provide a structured marketplace for the sale and purchase of health insurance. The authority and responsibilities of an exchange may vary, depending on statutory or other requirements for its establishment and structure. The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) requires health insurance exchanges to be established in every state by January 1, 2014. ACA provides certain requirements for the establishment of exchanges, while leaving other choices to be made by the states.
Qualified individuals and small businesses will be able to purchase private health insurance through exchanges. Issuers selling health insurance plans through an exchange will have to follow certain rules, such as meeting the private market reform requirements in ACA. While the fundamental purpose of the exchanges will be to facilitate the offer and purchase of health insurance, nothing in the law prohibits qualified individuals, qualified employers, and insurance carriers from participating in the health insurance market outside of exchanges. Moreover, ACA explicitly states that enrollment in exchanges is voluntary and no individual may be compelled to enroll in exchange coverage.
Exchanges may be established either by the state itself as a “state exchange” or by the Secretary of Health and Human Services (HHS) as a “federally-facilitated exchange.” A federally-facilitated exchange may be operated solely by the federal government, or it may be operated by the federal government in conjunction with the state, as a “partnership” exchange. All exchanges are required to carry out many of the same functions and adhere to many of the same standards, although there are important differences between the types of exchanges. States had to declare their intentions to establish their own exchange no later than December 14, 2012; to date, 17 states and D.C. have received conditional approval from HHS to operate a state exchange. States interested in pursuing a partnership exchange must declare their intentions no later than February 15, 2013.
ACA and regulations require exchanges to carry out a number of different functions. The primary functions relate to determining eligibility and enrolling individuals in appropriate plans, plan management, consumer assistance and accountability, and financial management. ACA gives various federal agencies, primarily HHS, responsibilities relating to the general operation of exchanges. Federal agencies are generally responsible for promulgating regulations, creating criteria and systems, and awarding grants to states to help them create and implement exchanges.
A state that is approved to operate its own exchange has a number of operational decisions to make, including decisions related to organizational structure (governmental agency or a nonprofit entity); types of exchanges (separate individual and Small Business Health Options Program (SHOP) exchanges, or a merged exchange); collaboration (a state may independently operate an exchange or enter into contracts with other states); service area (a state may establish one or more subsidiary exchanges in the state if each exchange serves a geographically distinct area and meets certain size requirements); contracted services (an exchange may contract with certain entities to carry out one or more responsibilities of the exchange); and governance (governing board and standards of conduct).
In general, health plans offered through exchanges will provide comprehensive coverage and meet all applicable private market reforms specified in ACA. Most exchange plans will provide coverage for “essential health benefits,” at minimum; be subject to certain limits on cost-sharing, including out-of-pocket costs; and meet one of four levels of plan generosity based on actuarial value. To make exchange coverage more affordable, certain individuals will receive premium assistance [...]
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WASHINGTON (Reuters) – Five Republican governors rejected on Friday a major provision of President Barack Obama’s healthcare reform law that calls on states to set up online health insurance markets where consumers can purchase private coverage at federally subsidized rates.
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Former Green Bay Packer great, Reggie White passed away due to the effects of sleep apnea. Active Healthcare wants you to be sure that you are getting the care and help you need to treat your sleep apnea. Visit ActiveHealthcare.com for educational resources and support.
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Delegates from Arizona, Texas, Washington, and Wyoming confess their fears over GOP proposals to rescind President Obama’s Affordable Care Act and restrict abortion rights.
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BERLIN (Reuters) – Berlin’s senate said doctors could legally circumcise infant boys for religious reasons in its region, given certain conditions, ending months of legal uncertainty after a court banned the practice this year.
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The Feed-in-tariff is the 9th wonder in the world. The FIT is a giant economic step forward for human kind. PG&E is the enemy of California. Obama and the Tax Cuts for the Wealthy:: As bad as Obama’s failing to serve the 99%, both on jobs and on healthcare, the most glaring violation of his economic campaign promises was when he broke his campaign promise to let the tax cuts for the 1% expire. This is such a flagrant violation of a campaign promise that it should have already undermined him with most of his 2008 supporters. Political spin is truly creative, though, and Obama apologists, the Obama administration, along with a complicit media have constructed a false narrative that lets Obama off the hook. The narrative in brief: Obama did his best but the Republicans forced him to break the promise. This narrative is fiction but we need to examine it in detail to see why. The public wanted the tax cuts to expire. Buffett, the billionaire investor, wanted the government to raise taxes on the rich. Dozens of America’s wealthiest taxpayers — including hedge fund legend Michael Steinhardt, super trial lawyer Guy Saperstein, and Ben Cohen of Ben & Jerry’s fame —appealed to President Obama not to extend the Bush tax cuts for anyone earning more than million a year. The opportunity for Obama to fulfill his campaign promise on taxes arose just before the elections of 2010. Republican Senators dug in for a battle. They told Senate Majority Leader Harry Reid that they would shut …