The New Health Care Reform: Insurance Exchanges Print E-mail
Sunday, 21 March 2010 22:27
The new health care reform legislation will create state‐based health insurance Exchanges, for states that choose to operate their own exchanges, and a multi‐state Exchange for the others. The Exchanges will make health insurance more affordable and accessible for small businesses and individuals.

EXCHANGES
  • Create Exchanges where individuals and small businesses can compare and purchase health insurance online – among other places – at competitive prices.
  • For states that choose not to operate their own Exchange, there will be a multi‐state Exchange run by the Department of Health and Human Services.
  • State insurance commissioners will continue to provide oversight regarding consumer protections, rate review, and solvency.
  • Protects the financial integrity of the Exchanges through annual audits and financial reporting overseen by the Secretary of Health and Human Services, and establishes procedures and protections to guard against fraud and abuse.
ONE-STOP SHOPPING THAT PROMOTES CHOICE AND COMPETITION
  • Health coverage options available in a zip code will be listed on state‐based web portals and elsewhere.
  • Using the Internet and other means to present consumers with available plans will make purchasing health insurance easier and more understandable.
  • Individuals will be able to choose coverage among several benefit packages all including an essential set of benefits that provide comprehensive health care services with different levels of cost sharing.
  • To ensure competition, state Exchanges will have a national plan supervised by Office of Personnel and Management and may include state‐based non‐profit co‐ops and multi‐state insurance plans.
PROVIDE INFORMATION AND PROMOTE TRANSPARENCY
  • Requires standardized format, definitions, enrollment applications, consumer satisfaction, and marketing requirements to allow easy comparison of the prices, benefits, and performance of health plans.
  • Establishes a toll‐free telephone hotline to respond to consumer requests for assistance.
  • Creates online eligibility determinations with regard to health care premium tax credits or public programs, and consumers without access to the Internet will be able to enroll through the mail or in person in a variety of locations.
  • Health coverage Navigators in states will conduct public education activities, distribute information about enrollment and premium credits, and provide enrollment assistance.
  • Awards grants to states to establish, expand, or support health insurance consumer assistance.
ENSURE AFFORDABLE COVERAGE
  • Provides premium tax credits to limit the amount individuals and families up to 400% poverty spend on health insurance premiums.
  • Provides cost‐sharing credits for individuals and families up to 250% of poverty to help ensure affordable coverage.
  • Sliding scale tax credits are available to small employers with fewer than 25 employees and average annual wages of less than $50,000 that purchase health insurance for employees.