Developing Health Insurance Exchanges: Design Issues and a Model Statute for the States

The National Academy of Social Insurance announces a series of fast-track analysis compiling evidence from research and practice about health insurance exchanges. The implementation of health insurance exchanges in each state involves specifying the benefits packages to be offered to consumers, securing the participation of health insurance plans, collecting premiums from participating individuals and employers, making risk-adjusted payments to insurers, and generally overseeing the operation of the health insurance market. The extent to which the exchanges will succeed depends on how the states implement federal regulations and how the market place — including insurers, brokers, employers, and consumers — receives the exchanges.

Co-chairs Deborah Chollet, Economist and Senior Fellow at Mathematica Policy Research, and Sara Rosenbaum, JD, Harold and Jane Hirsh Professor of Health Law and Policy and Chair, Department of Health Policy, the George Washington University School of Public Health and Health Services will organize experts into work groups across such topic areas as Governance, Insurance Markets, Medicaid, Sustainability and Federalism to meet the implementation deadlines in the Affordable Care Act (ACA). This information will be distilled into the framework of a model statute with modules that states can adapt to their own circumstances. This model law will help states design exchanges, enact legislation, and plan regulations under the considerable discretion that ACA allows.

NASI is uniquely positioned to conduct such a comprehensive study quickly because its membership has creative and diverse expertise and the National Association of Insurance Commissioners (NAIC) is already working on a model statute and regulations and welcomes the collaboration. Stay tuned for more news as this project develops. This work builds on the findings of NASI’s 2009 study, Administrative Solutions in Health Reform, done in partnership with the National Academy of Public Administration (NAPA) and funded by the Robert Wood Johnson Foundation.