Health Policy Briefs: Health Insurance Exchanges

Abstract

On October 1, 2013, if all goes as planned, state health exchanges will fire up their respective web portals and kick off open-enrollment season, as part of the implementation of the Affordable Care Act (ACA). Individuals and small businesses will be able to purchase health insurance coverage that will take effect on January 1, 2014. A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation provides a primer on the exchanges and what lies ahead. It expands and updates points made in several previously released Health Policy Briefs. Topics covered in this brief include: What’s in the law? The original ACA intended for states to either establish a state-based exchange or default to a federally run system. However, since the ACA’s enactment, other models have evolved: the state partnership exchange, the marketplace plan management exchange, the bifurcated exchange, and the supported state-based exchange. The brief explains how each will operate. What’s the debate? The brief describes some of the issues states faced when deciding whether to run their own exchanges or to leave the task to the federal government. These include states’ ability to regulate and maintain control over their insurance markets; the importance of a customized consumer outreach plan for a state’s population; and the exchange’s willingness to coordinate with state and federal programs, such as Medicare and Medicaid, allowing consumers to seamlessly enroll in either private or public programs through the exchange. Finally, states opting to start their own exchanges received federal startup grants. States choosing the federal exchange may have been concerned about the cost of sustaining the exchanges once these grants end. What’s next? The key milestones ahead include testing state and federal information technology systems, certifying plans, and training and certifying navigators and those who will assist consumers with enrollment. With the wide flexibility afforded states to choose an exchange model, it will be critical to watch how these differences affect insurance markets and, ultimately, consumers’ access to adequate, affordable health care. NOTE: This Health Policy Brief is based on the authors’ previously published paper, made possible with support from The Commonwealth Fund.