Risk Pools
States can merge or keep separate individual and small group markets. Merging markets can stabilize premiums and reduce rates for individuals, but may increase small group premiums and affect available strategies to avoid risk selection.
*Milestone details:
*Full name: Decide whether to keep separate or merge the individual and small group market risk pools.
*Relevance to the ACA:
The ACA gives states the option to either merge or keep separate their individual and small group markets, excluding grandfathered plans. Relevant sections include:
§1312 - Requires insurers to consider all enrollees in the individual market to be part of one risk pool and all enrollees in the small group market to be in one risk pool, regardless of whether they purchased coverage through the Exchange, unless they are enrolled through a grandfathered plan. A state also has the option to require that individual and small group markets be merged.
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District of Columbia
This amendment to an interim final rule prohibits undocumented immigrants affected by a recent executive order from enrolling in the Preexisting Condition Insurance Plan (PCIP) or coverage through the exchange.
District of Columbia
At their February 27, 2012 meeting, the COHBE board decided to keep the administration for the SHOP and Individual Exchanges combined, while maintaining separate risk pools. See attached board minutes.
District of Columbia
Rhode Island's legislature recently passed legislation requiring a number of studies by October 1, 2012, including: a study on the Basic Health Program, merging individual and small group markets and insurance product consistency inside and outside the exchange.
District of Columbia
A set of recommendations by exchange staff call for one administrative structure for both exchanges in order to maximize efficiencies, but recommends against merging the individual and small group markets at this time and revisiting the decision later. At a recent meeting, the board approved these recommendations, and decided to initiate a study on keeping the markets separate.
District of Columbia
This bill, introduced by the House of Representatives, would establish a state health benefits Exchange and requires its governance structure to be in place by July 2012. The bill leaves many future decisions up to the legislature and governor, but does specify that the Exchange shall be governed by a public-private partnership. The Washington State Health Care Authority, in consultation with the legislature’s Joint Select Committee on Health Reform Implementation, would develop a set of options for a variety of implementation decisions. Access the bill here: http://www.statereforum.org/sites/default/files/1740-s.pdf
District of Columbia
This bill establishes a Health Benefits Exchange and creates a health benefit development board. The board is charged with creating a development plan that contains recommendations on goals, functions, governance, regional exchanges, financial sustainability, market impacts, and plan certification. Access the bill here: http://www.statereforum.org/sites/default/files/wa_sb5445.pdf
District of Columbia
This issue brief explores the potential goals of an Exchange in WA, including: reducing the number of uninsured and increasing access to care; ensuring greater accountability and transparency; increasing the portability and continuity of coverage; simplifying health insurance purchasing; increasing competition in the health insurance marketplace; and driving quality improvement and cost containment. Access the brief here: http://www.statereforum.org/sites/default/files/waexchange_goalvalue_iss...
District of Columbia
These comments to HHS outline the major factors OR plans to consider in developing an Exchange. Access the comments here: http://www.statereforum.org/sites/default/files/or_hhspublic_comments.pdf
District of Columbia
This presentation to the Oregon Health Policy Board on April 13, 2010 outlines key decisions the board will have to make in order to align its own activities with the ACA. Access it here: http://www.statereforum.org/sites/default/files/or_axn_plan_12.10.pdf
District of Columbia
The purpose of this transition plan contained herein is to provide the incoming Executive Administration with key recommendations and information to assist in the successful implementation of national health care reform in New Mexico.
Access the plan here:
http://www.statereforum.org/sites/default/files/ohcr_transition_plan_122...
District of Columbia
House Bill 33 was introduced in the NM legislature in 2011. It would establish the structure, governance, and duties of the Exchange.
Access the legislation here:
http://www.statereforum.org/sites/default/files/hb0033.pdf
District of Columbia
This report, issued by the Illinois Health Care Reform Implementation Council, provides an overview of issues to be addressed immediately, such as establishing an Exchange as a quasi-governmental entity, and issues that will need to be addressed after more information gathering by the Council. The Council’s report also recommends establishing workgroups focused on systems design, workforce, and quality improvement.
Access the report here: http://www.statereforum.org/sites/default/files/il_hric_initial_report.pdf
California
This report summarizes the input of MD's workgroup on exchanges and their views on major decision points and functions of the exchange, including governance, regulation, and market structure.
Access the report here:
http://www.statereforum.org/sites/default/files/md_finalreportexchangewo...
District of Columbia
This proposed legislation establishes the framework for Pennsylvania’s exchange. The bill establishes a new authority governed by a board to run the exchange, and stipulates that the exchange for small businesses will be separate from the individual exchange. The proposed legislation also prohibits the exchange authority from regulating health insurance plans. Access the bill here:
http://www.statereforum.org/sites/default/files/pa_hb_2759.pdf
District of Columbia
This report, issued by the Commonwealth Health Care Reform Implementation Advisory Committee of Pennslyvania, provides an overview of the policy decisions the state will need to make to implement health reform. The report also provides the committee's recommendations for what actions the state should take. Access the report here:
http://www.statereforum.org/sites/default/files/pa_health_care_reform_im...
District of Columbia
California's enacted SB 1163 legislation establishes a rate review process for insurance plans in CA.
Access the legislation here:
http://www.statereforum.org/sites/default/files/sb_1163_bill_20100930_ch...
District of Columbia
This chart compares California's Exchange legislation with federal Exchange requirements. Access the chart here:
http://www.statereforum.org/sites/default/files/pdf_healthbenefitexchang...