A new report from The Commonwealth Fund provides recommendations for state and federal policymakers as they design and implement the new health insurance exchanges which are a key element of the Patient Protection and Affordable Care Act (ACA).
The state-based exchanges, to be set up by states and the federal government to provide a health insurance marketplace with subsidized health insurance for small businesses and individuals without employer or public coverage, will play a major role in enhancing many Americans' access to health insurance coverage when they are fully implemented in 2014.
The report by Timothy Stoltzfus Jost, Professor of Law at the Washington and Lee University School of Law, Health Insurance Exchanges and the Affordable Care Act: Eight Difficult Issues, examines issues that policymakers will grapple with as they work towards implementing the exchanges, and provides detailed recommendations to improve affordability and access to coverage purchased through the exchanges. These include how exchanges should be set up and governed; how they can avoid adverse selection—or having a disproportionately large share of high-cost enrollees, leading to unaffordable premiums within the exchange—and how to reduce administrative costs.
The author's recommendations include:
•In each state, the exchange should be placed within an independent agency, with a governing board that includes representatives of state agencies with which the exchanges must work, and others with relevant expertise.
•The U.S. Department of Health and Human Services should design a sophisticated but practical risk-adjustment system that will enable states to efficiently compensate insurers who have enrollees with above average health risks.
Exchanges and Large-Group and Self-Insured Plans
•States are allowed to open the insurance exchanges to large employers starting in 2017. The risk is that only large employers with unhealthy or older workforces will opt to come into the exchanges which could increase premiums for plans sold through the exchange.
•To counteract this possibility states should consider extending the requirements of the ACA to large plans and to grandfathered plans that qualify for exchange coverage and provide strong incentives for all firms of a given size to obtain coverage through the exchange.
Making Exchanges Work for Employers•The exchanges should offer employers the option of one bill covering the premiums of all employees, and should then allocate premiums among the various insurers and plans chosen by individual employees.
The Regulatory Role of Exchanges
•Exchanges should use their regulatory authority to lower prices and increase value to the extent that the competitive conditions in their markets allow.
•Exchanges should also standardize and limit the range of plan choices available within each benefit tier to stimulate competition based on price and value.
Exchanges as Sources of Descriptive and Evaluative Information
•To permit informed selection of an appropriate health plan through the exchange Internet portal, health plans should be contractually bound by information they disclose on their Web sites, and should develop rating systems that permit accurate comparison of the value of competing health plans.•When conducting their health plan evaluations, exchanges should be attentive to the opinions of both employers and individuals.
Exchanges and Public Subsidy Determination
•The exchange and public programs such as Medicaid and the Children's Health Insurance Program should facilitate electronic applications that minimize the need for paper documentation.
•Individuals should be permitted to apply initially either to the exchange or to the state Medicaid agency, with either agency ensuring that the individual is signed up for the appropriate program.
•Exchanges should see it as their responsibility to ensure the continued enrollment of eligible individuals and families for tax credits or public programs, rather than holding individuals responsible for continually having to work at maintaining their own eligibility.
Administrative Costs and Funding of the Exchange
•Exchanges should develop a variety of revenue sources to fund their work, including an assessment on all insurers in the market.
•Exchanges should seek opportunities to lower administrative costs both for insurers and for employers.
The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.
Mary Mahon | EurekAlert!
Team discovers how bacteria exploit a chink in the body's armor
20.01.2017 | University of Illinois at Urbana-Champaign
Rabies viruses reveal wiring in transparent brains
19.01.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn
An important step towards a completely new experimental access to quantum physics has been made at University of Konstanz. The team of scientists headed by...
Yersiniae cause severe intestinal infections. Studies using Yersinia pseudotuberculosis as a model organism aim to elucidate the infection mechanisms of these...
Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.
While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...
Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales
Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...
Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.
As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...
19.01.2017 | Event News
10.01.2017 | Event News
09.01.2017 | Event News
20.01.2017 | Awards Funding
20.01.2017 | Materials Sciences
20.01.2017 | Life Sciences