Since the passage of the Affordable Care Act, we’ve known
that state exchanges are a big part of the vision for reforming and expanding
health coverage. Although that
vision may have started about a bit hazy, it’s coming into sharper focus. State policymakers have been passing
laws and taking other action to give exchanges their general outlines. And today, HHS released two proposed
regulations that provide some further clarity. One covers a range of state exchange issues and the other
addresses the risk adjustment procedures that will encourage insurers to
compete on cost and quality.
They’re a useful start, but you might still have to squint, because
several exchange details have yet to be defined.
Along with today’s proposed rules, HHS released a fact
sheet that provides a good overview if you’re not setting aside time to pore
through the hundreds of pages of rulemaking. The proposed rules, on which HHS is
seeking public comment, cover:
* The timeline for states to adopt exchanges
* The basic functions of exchanges
* The qualification of plans to be offered through
* Some of the basics on the streamlined enrollment
* Initial guidance on navigator programs
* Options for the small business portion of exchanges,
* The opportunity for states to partner with HHS on some
We’ll be digging in more deeply to understand and
communicate the impacts of these rules on kids and families who need quality,
affordable health coverage. But
even with these proposed rules, we’re still waiting for more clarity on a
number of key concepts. This
proposal doesn’t address how families will qualify for the tax credits that
will help make exchange coverage affordable, nor does it cover what the minimum
benefit package will look like.
States will also need further guidance on how Medicaid eligibility
determinations will change in 2014 to align with exchange processes. We’re expecting further rulemaking on
these and other ACA topics later this year.