According to an article recently published in Health Affairs, if the Affordable Care Act (ACA) had been in place in 2001-2008, people in the individual insurance market would have saved about $280 per year on out-of-pocket costs. These savings would have been even more significant for people aged 55-64, as this age group racks up higher medical bills, but is still ineligible for Medicare. The root of the savings under the ACA is in the creation of the new health insurance exchanges, which make coverage more accessible for consumers in the individual market. Plans distributed through exchanges must cover essential health benefits, which include benefits such as prescription drugs and certain preventive services without copayments. The essential health benefit requirement in the exchanges will make the individual policies more generous and will create significant annual out-of-pocket savings for consumers. In addition, the study reports that the ACA reduces the risk of incurring high out-of-pocket costs. The likelihood of having out-of-pocket expenditures on care exceeding $6,000 would have been reduced for all adults with individual insurance, and the likelihood of having expenditures exceeding $4,000 would have been reduced for many.

Health insurance exchanges are a provision under the Affordable Care Act (ACA) and must engage in five core functions: 1) determine eligibility for federal subsidies or public coverage, 2) enroll consumers and employees into qualified health coverage (or connect eligible individuals with Medicaid and CHIP), 3) conduct plan management, 4) provide consumer assistance, and 5) perform financial management. The Center on Health Insurance Reforms at Georgetown University Health Policy Institute and the National Academy of Social Insurance (NASI), with funding from the Robert Wood Johnson Foundation (RWJF) recently released a paper focuses on one of these core functions: the series of oversight activities that federal officials have called “plan management.” States face three choices: establish their own exchange and exercise control over plan management functions, allow the federal government to establish a federally facilitated exchange (FFE) but enter into a partnership arrangement to perform plan management, or cede all plan management functions to the FFE. With the latter two approaches, the state will essentially turn over to the federal government some of its traditional authority to regulate its private health insurance markets. However, through a partnership arrangement, state regulators can recapture that authority and oversight. The U.S. Department of Health and Human Services (HHS) has defined plan management to...

A new paper titled, “Multi-State Plans under the Affordable Care Act,” was recently released by the George Washington University School of Public Health and Health Services. Authored by Trish Riley and Jane Hyatt Thorpe of the GW Department of Health Policy and funded by The Commonwealth Fund, the paper examines key issues related to the development of multi-state plans (MSPs), a new type of insurance coverage created by a provision of the Affordable Care Act (ACA). MSPs will be administered through the federal Office of Personnel Management (OPM) and offered across state lines through the new state health insurance exchanges. The findings in this paper are based on interviews with federal and state policy makers and other stakeholders, and are intended to inform the development and implementation of MSPs. A primary goal of the ACA is to...

The Affordable Care Act's Health Benefit Exchanges (Exchanges) must be implemented in every state by January 1, 2014. The development of Exchanges will have a significant impact on how consumers access and sign up for coverage. National Academy of State Health Policy (NASHP) established the State Health Exchange Leadership Network, "a peer learning network for exchange leads." The purpose of the Network is to foster interaction and education as states move ahead with the design, construction, and execution of the Health Benefits Exchange market. This report examines key consumer-related issues and challenges that states must tackle as they plan and implement their Exchanges. Three main areas where consumers intersect with the Exchange are covered in the report...

The Affordable Care Act (ACA) requires states to create health insurance exchanges where individuals and small businesses can compare and purchase health insurance. One type of exchange created under the law is the Small Business Health Options Program (SHOP), which will offer group health plans to small companies. According to a recent report by the National Academy of Social Insurance (NASI), individual and SHOP exchanges will cover an estimated 28 million Americans by 2019, giving the exchange markets the same market power that large employers have, or even more. A new policy brief from Health Affairs and the Robert Wood Johnson Foundation examines SHOP exchanges...

The Robert Wood Johnson Foundation (RWJF) released a report today that explores three ways that states can comply with the Affordable Care Act's (ACA's) health insurance exchange provision. First, states can establish an exchange of their own; second, states can default to a federal exchange; or third, states can create a hybrid exchange. On behalf of the National Academy of Social Insurance (NASI), the authors evaluated the considerations associated with each option to help states determine which model may work best for the unique needs of their residents. Although the underlying goals are the same in all three Exchange models, there are differences in the amount of flexibility and autonomy granted to the States with each. State Exchanges, for example, offer the greatest independence in functions like coordinating plan enrollment, eligibility, and financial management. States cede much of this autonomy with the Federal Exchange model. As its name implies, the Hybrid Exchange allows states to retain responsibility for certain core functions, while importantly, also providing an interim pathway for an eventual State Exchange. The authors conclude that regardless of the model, success can only be achieved through intensive collaboration between individual states and the U.S. Department of Health & Human Services.