The headline on reads, “Coming in 2014: Affordable Insurance Exchanges.” The page describes the new health care markets coming to a state near you. To a person, the federal and state policymakers tasked with launching the Exchanges will say that 2014 feels like tomorrow. And while few are likely to predict that states will or will not be ready, tools to build the Exchanges are under development and there is forward motion.   On July 11, the Department of Health and Human Services released proposed rules supporting the implementation of the Exchanges and seeking comments by the end of September.

While the Center for Consumer Information & Insurance Oversight (CCIIO) has generated a preliminary impact analysis of the proposed rules, the comments offered through the proposed rulemaking process and other information from the multitude of constituencies that will be affected by this new mode of coverage will certainly help to shape the Exchanges.  A new brief released by the Changes in Health Care Financing and Organization (HCFO) initiative, a program of the Robert Wood Johnson Foundation, administered by AcademyHealth, captures the goals, concerns, and guidance from insurers, actuaries, state insurance commissioners and others with strong interest in the development of Exchanges. These groups and others were represented at a meeting convened in April 2011 during which participants discussed the many factors that will affect health insurance pricing decisions both inside and outside the Exchanges. Of particular concern to participants were: 
  • The shape and size of risk pools, including whether sufficient healthy individuals remain in the pools.
  • Uncertainty in the marketplace, including the future role of agents, brokers and navigators as information sources, particularly to guide new entrants into the market.
  • The changing determinants of pricing, including the many new features of health reform that are likely to influence premium levels.
The sharing of information is critical as 2014 approaches, particularly between the chief architects of Exchanges, the state and federal policymakers. As noted in the brief, “[a] request was made for frequent communication through conference calls between the federal government and states, with bi-directional information flow to assist states in understanding federal requirements and federal policymakers in understanding implementation challenges.” This post was written by Bonnie J. Austin, J.D., a director at AcademyHealth.
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