Health Insurance Exchange Regulations and the Health Reform Challenge

David Harlow

Posted 3/18/12 on HealthBlawg

The federal Health Insurance Exchange regulations were released in final form last week. (See Timothy Jost’s précis on the Health Affairs blog and HHS presser.)

I had the opportunity to hear Pennsylvania Insurance Commissioner Michael Consedine speak in Philadelphia about his state’s progress towards building an exchange the very next day (I was speaking later on the program). Pennsylvania is one of the 26 states challenging the federal health reform law (and even has a state constitutional amendment afoot that would bar implementation of the individual mandate in PA), but that hasn’t stopped the Keystone State from spending a $1 million planning grant and getting a $33.8 million implementation grant to kick their state health insurance exchange into high gear. (Nothing like playing both sides, eh?)

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Will the Feds Be Ready With the Fallback Insurance Exchanges by October 2013?

Robert Laszewski

Posted 1/18/12 on Health Policy and Marketplace Review

Insurance exchanges have to be up and running in all of the states by October 2013 in order to be able to cover people by January 1, 2014.

If the states don’t do it, the feds have to be ready with a fallback exchange. States have to tell HHS if they intend to be ready by January 1, 2013.
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Implementing Reform: Funding and Flexibility for States on Exchanges

Timothy Jost

Posted 10/30/11 on The Health Affairs Blog

As 2011 comes to a close, we draw ever closer to January 1, 2014, the day when the most significant changes wrought by the Affordable Care Act will come into effect. Indeed, we are only weeks away from the halfway point between March, 2010, when the ACA was signed into law and October, 2013, the date when the exchanges will open for enrollment.

Yet few of the states seem to be halfway there. A few states have indicated that they will not be establishing exchanges under any circumstances, but more exchanges are simply stalled in the state legislative process, held up by stiff opposition to reform or by inertia and tight legislative calendars. Some states are also sitting it out, hoping that the Supreme Court makes the whole statute go away (which is, in fact, almost inconceivable as a legal matter).

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Interpreting the Draft Health Insurance Exchange Regulations

Roger Collier

First posted 7/31/11 on Health Care Reform Update

The Obama administration’s progress—with just a few stumbles—towards health care reform implementation took another major step this month. In a carefully chosen small business setting—a Washington DC hardware store—HHS Secretary Kathleen Sibelius released draft regulations for the health benefit exchanges called for by the Affordable Care Act.

The exchanges, required to be established for every state, are predicted to serve some 24 million consumers by 2019 (provided that the ACA is neither significantly changed nor found unconstitutional), with the majority receiving federal subsidies to help pay for coverage. So far, a dozen states have enacted bills to create exchanges, while in nine states such legislation has failed.

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Letting Go of Employer-Based Health Insurance

Jeff Goldsmith

First posted 7/22/11 on the Health Affairs Blog

Other than the egg-laying exercise surrounding the ACO regulations, 2011 was a quiet year among Washington health policy experts until June 6 when McKinsey released the results ofa survey of employer plans under the Affordable Care Act. The McKinsey study found that roughly 30 percent of employers were considering dropping their employee insurance coverage and encouraging their employees to receive federally subsidized health insurance through the Exchanges created in the Affordable Care Act. This compared to low- to mid-single digit estimated drop rates based upon economic modeling by the Urban Institute, Lewin and, importantly, the Congressional Budget Office (CBO).

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Health Insurance Exchange Regs Are Out, And They Make Me Feel Like A Visitor From The Future

David Harlow

First posted 7/12/11 on Health Blawg

Health Insurance Exchange regulations were released by HHS yesterday — in a DC hardware store, for local color and homespun truths — with a go-live date of January 1, 2014, per the Affordable Care Act, and a key interim approval deadline of January 1, 2013, by which date each state needs to demonstrate that it has its act together and are on a glide path to the go-live date. Despite the rancorous opposition to the ACA (consider, for example, the views of the Virginia Attorney General — who is leading a multi-state charge against the individual mandate — expressed at the American Health Lawyers Association Annual Meeting last month, where he was an invited keynote speaker, and later tweeted a tone-deaf assessment of the audience and an unkind skewering of a questioner who didn’t share his perspective), 49 states, D.C. and four territories have accepted health insurance exchange planning grants. Thus, it seems unlikely (for now) that the federales will have to make use of the “Do I have to do everything for you?” clause which would allow HHS to step in and set up an exchange for a state.

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Shifting Retiree Health Benefits

Paul Levy

First published 2/28/11 on [Not] Running A Hospital

In a recent post, I discussed the possibility that the new health care law many entice many employers to drop their company-provided health insurance plans and send their staff over to one of the new health insurance exchanges or Medicaid. Such a strategy, I noted, depends on a firm reaching a conclusion that having company-sponsored health insurance is not important to attract and retain workers.

But there is a group of people who are served by company-provided insurance whose competitive employment choices are no longer of any concern to the firm: Retirees.

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David Harlow

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