Health Exchanges

The Affordable Care Act (ACA) creates new health insurance state-based exchanges in 2014 for individuals and small businesses to shop, compare and enroll in health coverage. Individuals and small employers will be allowed to select plans offered through exchanges. New ACA subsidies are only available to eligible individuals and small employers who purchase coverage through an exchange.

The Department of Health and Human Services (HHS) and individual states are now developing the rules that will govern the operation of exchanges. Some states are considering "competitive" models that provide broad choices of health plans, while others are considering "active purchaser" exchange models that would pick and choose which health plans are available to consumers. Also, beginning in 2014, in order for insurance policies to be certified and offered in exchanges, they must offer a set of health service categories or "essential health benefits."

BCBSA believes that properly designed state health insurance exchanges can help consumers shop, compare and enroll in coverage. States should move forward to implement market-based exchanges, and HHS' rules should give states maximum flexibility to develop exchanges that best meet local needs.

To ensure all consumers have maximum choice, all qualified health plans that meet the requirements laid out in ACA should be available on the exchange. Allowing an exchange to pick and choose which health plans participate would give exchanges enormous power to dictate the choices available to consumers. State regulators - who are responsible for the entire market and assuring health plans have enough resources to pay claims - should continue to oversee premiums.