New healthcare exchange rules issued for states
The final shape for a key part of the health law — the state-based marketplaces where people will shop for insurance coverage — became clearer Monday in rules issued by the Obama administration.
Under the long-awaited rules, states will have broad flexibility to design their insurance marketplaces, which are set to begin operation in 2014. Some states are working to set up their marketplaces, called exchanges, while others have declined to move forward until the Supreme Court makes its decision on the constitutionality of the federal health law.
Responding to thousands of comments on earlier proposals, the administration made some changes, including setting a requirement that governing boards have at least one voting consumer representative. Earlier rules allowing up to half of the other members to have ties to the insurance industry stayed the same.
That disappoints consumer advocates, who would have preferred the governing boards “be dominated by consumers,” said Timothy Jost, who speaks as a consumer representative before the National Association of Insurance Commissioners and is a professor at the Washington and Lee University School of Law. But Jost said he is pleased the final rules require at least one consumer representative. “It at least gives a toe-hold,” he said.
The exchanges are seen as a key element in the health law, offering one-stop shops for individuals and small businesses looking to purchase health insurance. They will also help determine applicants’ eligibility for programs such as Medicaid, and for federal subsidies to help them purchase insurance. More than 21 million people will purchase coverage through the exchanges by 2016, according to Congressional Budget Office projections.
The Obama administration touted the 646-page set of rules as granting states great flexibility on how they design their exchanges, on the types of organizations - nonprofit or public agency - that will oversee them, and on whether to partner with the federal government to operate parts of it.
Monday’s announcement also included some “interim” rules, which could be tweaked after a 45-day public-comment period. These cover issues such as how quickly states must determine whether an applicant is eligible for Medicaid or the Children’s Health Insurance Program, and the role insurance brokers will play in helping low- and middle-income people apply for federal subsidies to buy coverage.