Health Insurance Exchanges

The Affordable Care Act (ACA) requires states to set up health insurance exchanges to give individuals and small businesses access to affordable health coverage. The federal government offered grants to the states for this purpose. The exchanges are slated to be in operation by January 1, 2014.

Government Resources
 State Actions 
Analysis

 

Government Resources 

HHS announced in a press release that Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington will receive more than $181 million in grants to help implement the new health care law. 5/16/12 (New) 

General Guidance on Federally-Facilitated Exchanges, CCIIO, 5/16/12 (New)  
 
Draft Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges, CMS, 5/15/12 (New) 

HHS has released final rules on the health care exchanges. The rules, proposed in the summer of 2011, set standards for establishing exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange and certifying health plans for participation in the Exchange. The regulations also establish a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs. 

HHS has announced more assistance to states as it implements the provisions of the Affordable Care Act, including a new round of Affordable Insurance Exchange Establishment Grants, totaling $229 million to 10 states, to help states build new health insurance marketplaces.

HHS and the Department of the Treasury have finalized the proposed rule outlining the steps States may pursue in order to receive a State Innovation Waiver under the Affordable Care Act. 

The IRS has released regulations to prescribe the procedures by which a qualified nonprofit health insurance issuer participating in the Consumer Operated and Oriented Plan (CO-OP) program may apply for recognition as a tax-exempt organization under the Internal Revenue Code. Written or electronic comments and requests for a public hearing must be received by April 9, 2012. 

2012 Progress Report: States Are Implementing Health Reform and News Release, White House, 1/17/12

News Release: HHS to Give States More Flexibility to Implement Health Reform, 12/16/11  

HHS has issued a final rule under the Affordable Care Act (ACA) to implement the Consumer Operated and Oriented Plan (CO-OP) program, which provides loans to foster the creation of consumer-governed, private, nonprofit health insurance issuers to offer qualified health plans in the Affordable Insurance Exchanges (exchanges). The goal of this program is to create a new CO-OP in every state in order to expand the number of health plans available in the exchanges with a focus on integrated care and greater plan accountability. 12/13/11  

New Federal Loan Program Helps Nonprofits Create Customer-Driven Health Insurers, 12/8/11 

News Release: States Receive More Flexibility, Resources to Implement Affordable Insurance Exchanges, 11/29/11  

FAQs on the Consumer Operated and Oriented Plan (CO-OP) Program, 10/11/11  

HHS has released a fact sheet plus additional information on Exchange Partnership opportunities for states. The Partnership model describes Exchanges where both HHS and a state work together to operate different functions of the Exchange. 9/19/11  

The U.S. Centers for Medicare & Medicaid Services (CMS) is requesting information regarding section 1331 of the Affordable Care Act, which provides states with the option to establish a Basic Health Program. This option permits states to enter into contracts to offer one or more "standard health plans" providing at least the essential health benefits described in section 1302(b) of the Affordable Care Act to eligible individuals in lieu of offering such individuals coverage through the Affordable Insurance Exchange. Public comments may be submitted on or before October 29, 2011. 9/14/11  

The U.S. Departments of Health and Human Services (HHS) and Treasury released three proposed rules related to establishing health insurance exchanges as required by the Affordable Care Act. Among other policies, the proposed rules describe how middle-class families will gain access to tax relief that will reduce the cost of coverage. The three proposed rules released by HHS and Treasury focus on the following:

  • Easy, Simple Access to Coverage for Consumers and Small Businesses: New rules will make it easy for consumers to enroll in high-quality health plans and get help paying for health coverage through premium tax credits and cost sharing reductions. Small employers participating in the Small Business Health Options Program will be able to offer their employees a choice of health plans and cut their costs with new tax credits.
  • Health Insurance Premium Tax Credit: Individuals and families will receive premium tax credits to help defray insurance costs, increasing access to health coverage for millions of middle class American families.
  • Medicaid Eligibility: Coordinating the Exchange with Medicaid and Children’s Health Insurance Program eligibility will make enrollment seamless for qualified Americans and reduce the administrative burden on states. 

Also, HHS Secretary Kathleen Sebelius sent a letter to governors laying out options and resources available to states to set up their exchanges. The letter solicits comments from states on how a partnership model can build on the substantial flexibility states have when designing an exchange that works for them. The regulations are open for public comment for 75 days. To facilitate feedback, the Administration will hold forums. These forums will help ensure more Americans have the opportunity to share their views regarding the establishment of the exchanges. Forums will be held in Atlanta, GA; Chicago, IL; Denver, CO; New York, NY; Portland, OR; and Sacramento, CA.

On July 18, 2011, the Department of Health and Human Services (HHS) proposed standards for establishing Consumer Oriented and Operated Plans, called CO-OP health insurance plans. CO-OPs are private, nonprofit health insurers with a board made up of members, designed to offer quality, affordable, consumer-friendly health plans in every state. Eligible organizations seeking to establish a CO-OP will be able to apply for a portion of the $3.8 billion in repayable loans made available under ACA to fund start-up and capitalization costs. The proposed standards reflect the recommendations of an independent advisory group that held many hours of public testimony by consumers, small businesses and providers. 


HHS has proposed a framework to assist states in building affordable insurance exchanges, state-based competitive marketplaces where individuals and small businesses will be able to purchase affordable private health insurance and have the same insurance choices as members of Congress. Regulations have been to proposed to offer states guidance and options on how to structure their exchanges including setting standards for establishing exchanges, certifying health plans for participation in the exchange, and ensuring premium stability for plans and enrollees in the exchange.


Website on health care exchanges, Center for Consumer Information & Insurance Oversight (CCIIO) 
 
Exchange Establishment Cooperative Agreement Funding FAQs, 6/2/11  

Health Insurance Exchange Grants Awards List, 5/23/11  

The HHS and the Treasury have proposed new rules outlining the steps states may pursue in order to receive a State Innovation Waiver under the Affordable Care Act.

The Health Insurance and Managed Care Committee of the National Association of Insurance Commissioners (NAIC) has approved the American Health Benefit Exchange Model Act, designed to aid states in establishing health insurance exchanges. The model act must be approved by the full NAIC before being recommended for states to adopt. 

HHS has awarded nearly $49 million to help 48 states and the District of Columbia plan for the establishment of health insurance exchanges. 

On July 29, 2010, HHS announced the availability of grants to help states begin work to establish health insurance exchanges. HHS also is requesting public input on developing standard for the exchanges.

State Actions


Analysis