Federal blueprint frames out insurance exchange plans

The Department of Health & Human Services (HHS) on May 16 released guidance for states to provide details to the federal government on how they will run their online insurance marketplaces. Details are due to HHS by Nov. 16, 2012, according to the blueprint document.

States that don’t meet the deadline – or that can’t operate their own marketplaces, called exchanges  – will have it done for them by the federal government, starting in January 2014.

The marketplaces, which are mandated by the 2010 Affordable Care Act, are designed to increase competition among insurers and to make coverage more affordable. States can choose to run the exchanges, elect to perform only some services or cede control to the federal government, officials said in the guidance. HHS “will seek to harmonize…policies with existing state programs and laws wherever possible,” according to a separate report offering a few details on what a federal exchange might look like.

While the guidance does not indicate whether there will be a governing board overseeing the federal exchanges, it does say the federally overseen marketplaces will accept any insurer that meets the basic requirements.

Some consumer groups, including the American Cancer Society Cancer Action Network wanted the federal government to be more selective, in hopes that it would drive insurers to compete harder on pricing and quality measures.

Steve Larsen, the official overseeing the federal exchange effort, said the initial approach would be an open marketplace, but he told reporters that in future years other options may be explored.  States that run their own exchanges are free to choose whichever model they prefer.

While many states are moving forward  – 34 have received federal grants to pay for planning efforts – others are moving slowly or not at all.  Six states — Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington — received additional grants on May 16 totaling more than $181 million.

According to news reports, officials in some states say they are holding back pending the Supreme Court’s decision on the constitutionality of the health law, expected at the end of June.  The court could uphold the entire law, strike it down entirely or eliminate some parts of it.

Other state lawmakers have said they want to hold off on creating the marketplaces until after the results of the November election (Nov. 6) are known.  Larsen reiterated the government’s stance that the court will uphold the law and that the president will be re-elected, and he said “states should turn their attention to moving forward.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Image attributed to Dariusz Kozlowski via Creative Commons license.

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