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...

A series of in-depth case studies based on site visits and reports from national data sets tracks how the Affordable Care Act (ACA) is being implemented in states and establishes a baseline for measuring progress over the coming years. The reports, prepared by researchers at the Urban Institute and Georgetown University’s Health Policy Institute, are designed to share background information, processes, and learnings that can inform the work of state government agencies, policy-makers, and others across the country as ACA implementation progresses. In the first reports, the authors found that...

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...

Under the Affordable Care Act (ACA), many more Americans will be eligible for health insurance through state insurance exchanges by 2014. Many of these individuals are among the 90 million American adults who lack basic health literacy – the ability to process and understand the information needed to make appropriate health decisions. The IOM Roundtable on Health Literacy held a workshop on July 19, 2011, that explored ways in which health literate communication techniques can improve communication to potential enrollees. The workshop focused on lessons learned from existing exchanges, the effect of exchanges on consumers, the relevance of health literacy to the exchanges, and the current best practices in developing materials and communicating with consumers.

The Robert Wood Johnson Foundation and the National Academy of Social Insurance recently released "Building a Relationship between Medicaid, the Exchange and the Individual Insurance Market," which examines the practical and conceptual factors that underlie the federal/state relationship in dealing with the alignment of Medicaid and the State Health Insurance Exchange policy. The report lays out dimensions of collaboration between states and the federal government that could help establish a seamless continuum of coverage for those who may move between eligibility for Medicaid and for tax subsidies in the Exchange.

This spring, as the Affordable Care Act (ACA ) celebrated its first birthday, Massachusetts commemorated five years since the implementation of its revolutionary health reform law, passed in 2006. Marking these milestones, the Blue Cross Blue Shield of Massachusetts Foundation, the Robert Wood Johnson Foundation, and the Commonwealth Health Insurance Connector Authority developed the Health Reform Toolkit Series to offer insight on key health reform topics to state leaders in the process of ACA implementation. The Blue Cross Blue Shield (BCBS) of Massachusetts Foundation recently published the fourth report of the series, “Mitigating Risk in a State Health Insurance Exchange.” This toolkit focuses on the ACA's three key strategies intended to mitigate adverse selection and stabilize health insurance premiums when insurance market reforms are implemented in 2014. These strategies are also designed to decrease health insurance plans’ economic incentives to employ tactics designed to enroll healthier persons. These three risk mitigation strategies include: 1) Risk corridors; 2) Reinsurance; and 3) Risk adjustment. By mitigating risk to health insurers, these three strategies – along with standardized product designs – work together to allow issuers to compete on quality, efficiency, and value, rather than on the basis of designing products intended to attract and enroll only the healthiest individuals.