The Exchange Challenge
With the Jan. 1, 2013, “readiness review” deadline approaching for state-based health insurance exchanges mandated by the Patient Protection and Affordable Care Act, local officials face a quagmire of legal and federal red tape to bring the exchanges to life. “In selecting among a range of Exchange options, states face complex challenges in balancing the desire for autonomy with the opportunity to rely on federal solutions for new responsibilities required of all Exchanges,” says Deborah Bachrach of the National Academy of Social Insurance, a Washington, D.C., think tank that examines national insurance issues and trends.
Bachrach is the co-author of a December 2011 report “Federally-Facilitated Exchanges and the Continuum of State Options,” which analyzes the social impact of the Affordable Care Act on states, with a focus on health insurance exchanges. She and her co-author, Patricia Boozang, argue that “some states will no doubt be positioned to stand up a State-based Exchange (SBE) on Jan. 1, 2014, which requires at least conditional certification from the Department of Health and Human Services (HHS) on Jan. 1, 2013. Others will not and will choose instead to rely on a Federally-facilitated Exchange or a Partnership Exchange wherein the state will assume some of the exchange functions that would otherwise be performed by the Federally-facilitated Exchange.”
Their report, which his downloadable for free at www.nasi.org , suggests how the core functions of the exchange might be effectuated in state-based, federally facilitated and partnership exchange models and the legal, operational and fiscal implications of each.