The New Health Insurance Exchanges: Making Them Work

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</p>When new state-based health insurance exchanges become fully operational in 2014, they will serve as major marketplaces for health coverage, providing many currently uninsured and underinsured Americans with an affordable, easy way to obtain comprehensive coverage. In a new <a href="/publications/fund-reports/2010/sep/health-insurance-exchanges-and-affordable-care-act-eight">Commonwealth Fund report</a> and <a href="/blog/2010/health-insurance-exchanges-overcoming-implementation-barriers">blog post</a>, Timothy Stoltzfus Jost of the Washington and Lee University School of Law writes that if exchanges are to work as intended by the Affordable Care Act, federal and state governments will have to tackle a number of thorny issues throughout the implementation process, including: <ul><li>How should the exchanges be governed? Jost argues that each exchange should be placed within an independent agency that is explicitly exempted, as necessary, from specific state administrative law or government operations requirements. <br /><br /></li><li>How can exchanges deter adverse selection? Each state’s regulation of the individual and small-group market should be identical inside and outside the exchange, Jost says, so that the exchange doesn’t include only high-risk individuals with costly health care needs.<br /><br /></li><li>How should large employer plans, particularly formerly self-insured employee benefit plans, be incorporated in the exchanges?<br />  <br /></li><li>Can exchanges be made attractive to employers? One option: offer employers the possibility of getting an aggregated bill covering the premiums of all their workers.<br /> <br /></li><li>How should participating plans be regulated? Jost believes exchanges must use their certification power to ensure that health plans meet the statutory requirements for qualification and that plans don’t impose unreasonable premium increases on their members.<br />  </li><li>How will consumers be able to compare plans? Information about the benefits and limitations of various health plan choices should be easily accessible; in fact, plans should be contractually bound by the information they disclose on their Web sites, Jost argues.<br />  </li><li>How will eligibility for premium tax credits and cost-sharing be determined? Exchanges should be responsible for ensuring continued enrollment of eligible individuals and families in tax credits or public programs, says Jost.<br />  </li><li>How can exchanges reduce administrative costs and attract funding? </li></ul><p>Join Timothy Jost in a Fund webinar on Nov. 4 at 2 p.m., when he will be discussing these important issues. To register, go to <a href="">https…;