What are Health Insurance Exchanges?

One of the key debates during this year’s political campaign was the 2010 Patient Protection and Affordable Care Act.  Under the term “Obamacare,” as everyone now calls it- more than 24 million uninsured Americans will get extended health coverage beginning in January 2014.

The Affordable Care Act (ACA) requires each state to establish a Health Insurance Exchange by 2014, where individuals can purchase affordable health insurance coverage.   Under the law, each state must decide whether to expand Medicaid coverage for lower income Americans or form a health care exchange program.  The exchange program will be an online marketplace where individuals can shop for health insurance in a more “competitive” environment.

Who can purchase insurance through Exchanges?

Eligible individuals include U.S. citizens and legal immigrants who do not have access to or cannot afford insurance through their employer.  This includes unemployed Americans and early retirees who are not yet eligible for Medicare.  In addition, small businesses that have fewer than 100 employees (50 or few in some states) and the self-employed will be eligible to purchase coverage through small business exchanges.

Which states are on track for setting up the Exchanges?

Currently, sixteen states and the District of Columbia are on track to set up their own exchanges. However, nine states have opted out of developing a state-based Exchange as part of the implementation of the Affordable Care Act.  According to Americans for Prosperity, “States can and do have the power to tell the federal government no!  By creating an exchange, states will serve as de-facto administrators of the federal government implementing its rules, regulations and mandates.” According to Indiana Governor-elect Mike Pence, “It is not clear that Indiana residents would benefit from incurring the cost of implementing the new federal healthcare bureaucracy.” Pence has also noted that he remains opposed to a partnership Exchange with the federal government.  However, he has pledged that he will explore “the best course of action for the people of the state and will make every effort to develop locally-based, innovative solutions…”

What is next?

Governors have only two choices:  Devise an insurance exchange for their states or leave it up to Washington to do it for them.  For the nine states opting out of developing an Exchange, eligible residents will still have access to a Health Insurance Exchange starting in 2014. However, they will access an Exchange run by the federal government.  For additional information:  Health Reform: A Guide to Health Insurance Exchanges can be found on:  http://www.kaiserhealthnews.org


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