Health Care Exchange

October 20, 2010, 10:23 AM

Beginning in 2014, the Patient Protection and Affordable Care Act (PPACA) will mandate that new state based marketplaces are created to offer small businesses and otherwise uninsured individuals affordable health insurance plans that meet certain government prescribed benefits standards. This is what has been referred to as the health care exchange. Most, if not all, of us have heard of the concept of the insurance exchange, but many of us still have questions as to how exactly the exchange will work and what it will look like. Of course, many of the answers to these questions will have to wait for the Centers for Medicare and Medicaid Services (CMS) to issues regulations to implement the exchange, but this post will discuss in a very general manner the overall goal and approach to the implementation of the health insurance exchange concept.

The basic plan is to create a system pursuant to which the Secretary of Health and Human Services establishes an essential benefits package that will delineate certain minimum benefits that will be offered to all recipients of health insurance participating in the exchange. The Secretary will establish different levels or tiers of health plans that will offer differing levels of benefits (i.e. bronze, silver, gold, platinum plans) at different costs to the consumer. Exchange participants will be able to shop around and compare rates from different carriers that participate in the exchange, with the thought being that exchange participants will be able to make an informed decision based on side by side comparison shopping for health insurance, much like a consumer may currently shop around for the best auto insurance rates while comparing the rates of more than one auto insurance company.

Of course, more details regarding implementation will emerge as CMS begins to implement the health insurance exchange and Kaufman & Canoles' Health Care Practice Group will continue to monitor new developments and keep current on the implementation of the health insurance exchange. --Aaron J. Ambrose