Question

In an essay, define and describe the federal-default exchange program and indicate if any of the states listed in Exhibit 22.1on page 395 have become or anticipate becoming fully self sustaining by the end of 2015 as dictated in the Affordable Care Act (ACA).

Please use the reference below for exhibit 22.1

Morrisey, M. A. (2014). Health insurance. Chicago, IL: Health Administration Press.

Answer 1

As per Morrisey, M. A. (2014). Health insurance. Chicago, IL: Health Administration Press :

One of the features of the Affordable Care Act, which was signed into law in 2010, was the creation of state and federal health insurance exchanges. A health insurance exchange is an organized selection of qualified individual health insurance plans. The design of the exchange allows you or your employer to more easily compare the benefits, price, and even quality of the various before purchasing your desired level of coverage. Some individuals or families may even be eligible to receive tax credits for purchasing their health coverage through an insurance exchange.

According to the U.S. Department of Health and Human Services, each state will be allowed to structure its own health insurance exchange as a nonprofit entity, as part of a state agency already in existence, as an independent public agency, or in partnership with other states as a regional insurance exchange. Each state will be able to determine how many and what type of health plans to offer through its exchange.

Not every state will be participating in the health insurance exchanges, however. The federal health insurance exchange will kick in for individuals who live in states that choose not to participate. The federal insurance exchange may operate through a nonprofit entity or as an independent agency. Federal insurance exchanges will be carefully customized to meet individual state and local health care needs.

States that are struggling financially may opt out of state exchanges, while states that prefer to have more control over their affairs may choose instead to maintain their own insurance exchanges and avoid federal interventions when possible. Federal health exchanges may also partner with states in some cases until the states are able to manage their exchanges independently.

Federal Responsibilities in a Partnership Exchange

In a partnership exchange, the FFE performs all functions other than plan management, in-person consumer assistance, or both, depending on which partnership model a state selects.

16 These include, but are not limited to, the following functions:

z Operation of a toll-free consumer call center for the exchange

z Design and operation of a public exchange website

z Design of the single application for coverage

z Selection and financing of navigators

z Eligibility determination for premium tax credits and cost-sharing reductions

z Enforcement of the individual responsibility requirement to maintain coverage and approval of exemptions from the requirement

Conclusion:

As exchanges will become the key vehicle for individuals and small businesses to obtain health insurance in 2014, it is critical that the entities responsible for plan management and in-person consumer assistance perform these functions well in all exchanges. A clear understanding of the roles and obligations a state will have in plan management and consumer assistance partnership exchanges is necessary to determine whether a state should pursue a partnership model. This piece, along with the HHS blueprint document18 upon which it is based and Families USA’s companion piece