Questions on State Insurance Exchanges

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Questions on State Insurance Exchanges

As policymakers consider legislation and/or regulations to establish a competitive marketplace in your state for consumers to purchase health insurance that best meets their needs, advocates should ‘encourage’ the media to ask these six core questions. Answers will greatly help to inform the public whether your state is choosing to operate a state-run exchange, to participate in a state-federal partnership exchange, or to implement a federally facilitated exchange. If the media is not asking these questions, remember the formula Q = A + 1 and proactively insert the information.

1. What type of insurance plans will be included in {STATE’s} exchange?

  • Will {STATE} choose to be an ‘active purchaser’ by setting solid standards that insurers must meet in order to offer their product on the exchange?
  • If so, what are those standards?
  • Or will {STATE} be a passive purchaser and allow any insurer/plan on the exchange?

2.  The health law includes strong conflict of interest protections so that insurance companies with proprietary interests in how the exchange operates are not sitting on its governing board. Who will sit on the governing board of {STATE’S} exchange?

  • How is {STATE} assessing conflict of interest?
  • Are people affiliated (now or in recent past) with insurance companies allowed on the board?
  • Will consumers and patient representatives be on the board?
  • Will the board conduct open meetings and seek public input?

3.  How will {STATE} make sure the exchange will be accessible to everyone?

  • How will people who speak/read different languages be accommodated?
  • Will multiple formats (web-based and printed) of the exchange be available?
  • Will the information provided include everything a consumer needs to know to make an informed decision—premium rates, enrollment forms, an apples to apples comparison list of covered benefits, cost-sharing rules, provider networks, appeals process, measures of customer satisfaction?

4.  Are the rules for plans outside {STATE’S} exchange as strong as those for plans in the exchange?

  • If the rules are less stringent, insurance companies can cherry pick the healthiest customers and leave people with health problems in the exchange (exchange pool becomes higher risk)—driving up the cost of coverage on your exchange.

5. How is {STATE} integrating its exchange with the Medicaid program?

  • Exchanges should tell consumers if they are eligible for Medicaid and federal tax subsidies (and, if so, how much). This is especially important for people with incomes that fluctuate throughout the year, requiring them to move back and forth with continuous coverage.

6. {STATE} has received money from the federal government to design, set-up, and implement our exchange. How is {STATE} planning to fund the exchange is the future?

  • What will {STATE’S} steady, predictable funding source be?
  • Will {STATE} establish fees for insurance companies to pay to offer their products for sale?
  • Does that include plans that choose to stay outside the exchange?
  • Or will it rely on annual appropriations, which will be less predictable and add to taxpayer costs?