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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 sc732@georgetown.edu 202-687-3003