The Affordable Care Act of 2010 mandates states to set up affordable health insurance exchanges – the web-based portals for selling health insurance at competitive rates to US consumers.
The US government has granted states the flexibility to design their own exchanges based on the insurance needs of their local insurance markets and residents. States thus have an option to set up their standalone exchanges, opt for federally run health insurances or create an insurance exchange in partnership with federal government. All the three models have been discussed in detail below:
State run exchanges: In state run exchanges, states would run all health insurance exchange related Services, but states would have an option to use federal government services for determining tax credits and cost sharing reduction figures and using other services such as exemptions, re-insurance programs & risk adjustment programs.
Federally run exchanges: In this model, the US government would be responsible for all the exchange related activities, although states can chose to participate in the program and use some federal services for activities such as reinsurance program, determining CHIP and Medicaid eligibility etc.
State and federal government exchange partnership: In partnership health insurance exchange model, states can have the responsibility to administer and regulate participating health plans management activities and oversee the consumer assistance services for both individual and group markets, if they so desire. If states prefer they can also avail the option of using federal services for reinsurance programs and assessing and determine consumer eligibility for CHIP, Medicaid etc.
The US Dept. Of HHS can approve states for operating a state based exchange or state partnership exchange, considering if the US state submits an exchange blueprint comprising of two parts:
•A Declaration Letter
•Health Insurance Exchange Application
Any state that is looking to set up its own exchange or set up an exchange in partnership with the US government is required to submit an exchange blueprint before 30 business days of the exchange blueprint approval date of January 1. States that are planning of running a federally run exchange are required to submit a declaration letter, but are not required to submit an exchange application.
As the deadlines for health insurance exchange plan submission and implementation is drawing to near, states, already in the process of designing state health insurance exchange models, may need to gear up and ready their exchange blueprints before the established submission deadline. Whether or not the Affordable Care Act gets declared constitutional in the Supreme Court, states already en route to deigning their exchanges are likely to continue with their state health insurance exchanges. How the Supreme Court ruling affects the insurance exchange plans for other states, still remains to be seen!
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