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Health Insurance Exchanges and Affordability

Health Insurance Exchanges and Affordability. Yvette Fontenot, MPP Partner Avenue Solutions. Overview. Legislative History Exchange Models State Methods to Leverage Affordability Considerations for Advocates Premiums in 2015. Legislative History.

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Health Insurance Exchanges and Affordability

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  1. Health Insurance Exchanges and Affordability Yvette Fontenot, MPP Partner Avenue Solutions

  2. Overview • Legislative History • Exchange Models • State Methods to Leverage Affordability • Considerations for Advocates • Premiums in 2015

  3. Legislative History • Market reforms necessary to address individual and small group markets needed accompanying policy to work. • Exchanges are the necessary portal to enable apples-to-apples comparisons based on price and quality. • Debate over one national exchange, multiple, competing exchanges, or state-based exchanges. • Requiring exchanges to be selective was debated and rejected. • Result is states have flexibility and have adopted different approaches.

  4. Exchange Models • Selective Contractor: Only allows those insurers that advance exchange goals to participate and may manage plan choices through limits on the number or type of plans that an insurer can offer. • CA, MA, RI, VT • Market Organizer: Allows all insurers to participate but manages plan choices through limits on the number or type of plans that an insurer can offer. • CT, KY, MD*, NV, NY, OR • Clearinghouse: Allows all insurers to participate on the exchange with minimum requirements; does not manage plan choices. • CO, DC, HI, ID, MN*, NM, UT, WA Source: Dash S, et al, Key Design Decisions for State-Based Exchanges, The Commonwealth Fund, July 2013. * Maryland and Minnesota have authority to transition to selective contractor model after 2014.

  5. State Methods to Leverage Affordability • Informal rate negotiations between plans and exchange • Massachusetts • Private exchanges • Competition through greater transparency of rates • Oregon • Simplify choices to allow consumers to select a plan that offers the optimal level of protection • CA, CT, MA, VT* • Greater access to consumer tools to assess value and quality • OR, MD, MA, CO • Increase website’s user-friendliness and access to in-person assistance • Private exchanges • Bar sale of coverage outside exchanges or require that the same plans be sold inside and outside of the exchange • DC and Vermont Source: Monahan, C. et al, Realizing Health Reforms Potential, The Commonwealth Fund, December 2013

  6. Considerations for Advocates • Regulatory environment • Robustness of the market • Strength of in-person assistance in terms of availability and knowledge • Aggressiveness of current rate review process • Potential new partners

  7. Premiums in 2015 • Filings are due in May and will be released in November, at least by the Federally facilitated marketplace • Premiums likely to reflect assumptions about enrollment and enrollment mix which may vary by state • Delayed policy changes could impact premiums

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