Milestone: Decide whether to establish a state, sub-state, or multi-state Exchange or defer to the federal government
Deciding whether or not to establish a state-operated Exchange is the critical first step towards the creation of an Exchange that aligns with state priorities and goals.
*Milestone details:
*Full name: Decide whether to establish an Exchange at the sub-state level, the state level, participate in a multi-state Exchange, or defer to the federal government.
*Relevance to the ACA:
The ACA requires the establishment of health benefits Exchanges. It delegates primary responsibility to the states, but requires the federal government to step in for states that opt out. Provisions relevant to establishing an Exchange include:
§1311 - Establishes the Exchanges and creates grants for states to plan and launch them.
Also creates the option for regional Exchanges and sub-state Exchanges.
§1321 - Gives the Secretary of HHS the power to establish and operate an Exchange in a state that defers or whose Exchange does not meet statutory requirements.
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District of Columbia
Alabama’s Health Insurance Exchange Study Commission report was released in November 2011 and makes recommendations including: establishing the exchange as a quasi-governmental entity, keeping the individual and small group risk pools separate, setting up the exchange as a “free market facilitator,” and funding the exchange through an assessment on products sold both inside and outside the exchange.
Alabama
Alabama's Executive Order 17 of June 2, 2011 creating the Alabama Health Exchange Study Commission