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State Exchanges

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The Affordable Care Act (ACA) creates new state-based health insurance exchanges in 2014 to help individuals and small businesses shop, compare and enroll in health coverage. Individuals and small employers will be allowed to select a range of health plans offered through exchanges. If a state chooses not to set up an exchange, the federal government is required by law to set up a federal exchange.

The Department of Health and Human Services (HHS) and individual states are finalizing the rules that will govern the operation of exchanges. Rules on establishing exchanges issued by HHS in March provide significant state flexibility in designing exchanges to meet consumer needs. Additional exchange rules must be finalized in a short amount of time for states and other stakeholders to be ready for open enrollment in October 2013.

Some states are considering “competitive” market-based models that provide a broad choice of health plans, while others are considering "active purchaser" exchange models that would pick and choose which health plans are available to consumers.

BCBSA is a member of the Choice and Competition Coalition — a partnership of businesses, providers, brokers and insurers working to ensure that exchanges promote competition and preserve consumer choice.

BCBSA believes 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.

Read the Choice and Competition Coalition’s letter to Health and Human Services.

Visit the Choice and Competition Coalition’s website.