The Health Affairs Blog gives us a wonderful overview of the next phase of the Affordable Care Act implementation. The states are currently “50% in,” which means that half of the country will be dealing with the alternative federally created health insurance exchanges. Whether you are a potential patient, a physician, healthcare administrator or policy pundit, the following article is a must read… and, incidentally, the Policy ThinkShop blog could be an important resource for you this year…
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“The latest Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation explores the issues facing the federal government and the states in the establishment and operation of federally facilitated health insurance exchanges. These are the exchanges that will be created under the Affordable Care Act in states that do not elect to set up their own state-based exchanges, or to create and operate an exchange in partnership with the federal government.
At present, 25 states have opted for a federally facilitated exchange. The result is that the federal government will now have a major role in those states in expanding insurance coverage in the individual and small-group insurance markets.
Topics covered in this brief include:
Challenges in setting up the federally facilitated exchanges. Because of variations in state insurance laws, it may be difficult for the Department of Health and Human Services (HHS) to tailor an exchange to meet each state’s unique insurance market needs.
The potential of adverse selection: In a federally facilitated exchange, the federal government will only have a direct role in regulating the health insurance plans that are sold through that exchange–and not over other health plans in the state that aren’t sold through the exchange. There is a risk that healthy people in a particular state may opt for cheaper plans outside the exchange, while sicker people opt for the exchange coverage–a phenomenon known as “adverse selection.” There are risk-adjustment mechanisms in the health care law that could mitigate the gains and losses to different health plans, but these may take a while to work.”