Insurance Exchanges

Two models have dominated the policy literature on health insurance exchanges, with many hybrids borrowing elements of each. At one end of the policy spectrum, the insurance exchange can serve as a “marketplace” or “clearinghouse” where buyers and sellers transact with minimal regulation of the product features and prices. At the other end of the policy spectrum, the exchange serves as an “active purchaser” of health insurance on behalf of its clients, the individual consumers. This blogpost discusses what it means to be an active purchaser, and offers a case study comparing Covered California, which uses an active purchaser model, to two other exchange models and some early indications of the benefits of active purchasing.
 

Interest in new implementation approaches to health insurance marketplaces has increased as states seek to ensure the long-term financial stability of their exchanges and exercise local control over marketplace oversight. This brief explores the experiences of four states—Idaho, Nevada, New Mexico, and Oregon—that established their own exchanges but have operated them with support from the federal HealthCare.gov eligibility and enrollment platform. Drawing on discussions with policymakers, insurers, and brokers, this brief examines how these supported state-run marketplaces perform their key functions.

Most employers who provide health insurance to employees subsidize their premiums and provide a comprehensive benefit package. Before the ACA, people who lacked health insurance through a job and purchased it on their own paid the full cost of their plans, which often came with more limited benefits and higher deductibles. Findings from The Commonwealth Fund Affordable Care Act Tracking Survey, March–May 2015, indicate that the law’s tax credits have made premium costs in health plans sold through the marketplaces roughly comparable to employer plans, at least for people with low and moderate incomes.

States are developing accountable care organizations (ACOs) for their Medicaid populations to target health care costs and improve health care quality by better coordinating care for high-need, high-cost patients and reducing inappropriate inpatient and emergency department visits. Many high-need, high-cost Medicaid patients have mental health and substance use issues and are often not well-served in the current fragmented health care system. In response, states are increasingly looking to integrate behavioral health into their Medicaid ACO programs to help move the needle on cost and quality. This technical assistance tool examines four broad strategies states can use to integrate behavioral health services into ACOs.

The ACA provided for new publicly funded consumer assistance entities to help people on an ongoing basis as they apply for health coverage and subsidies and resolve questions and problems with their insurance once covered. These assistance professionals have unique insights into how ACA implementation is progressing, what is changing and what challenges remain. This report discusses the results of the 2015 Kaiser Family Foundation survey of Health Insurance Marketplace Assister Programs and Brokers, and compares the Assister Programs’ capacity and experiences during their first two years of operations under the ACA.