Insurance Exchanges

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.

The Marketplace Survey Improvement Guide helps Marketplaces improve consumers’ experiences when they shop for and enroll in a health plan. The Guide provides seven evidence-based strategies that will help Marketplaces improve the consumer experience by giving consumers accurate and relevant information in a timely manner and helping consumers understand and use that information. The Guide also offers recommendations on where to focus improvement efforts.

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.

In the wake of the U.S. Supreme Court’s recent decision in King v. Burwell affirming the availability of federal subsidies to states opting to use the Federally-Facilitated Marketplace model, there is growing interest in state and federal marketplace options and performance. While states implementing both the FFM and SBM models had to overcome hurdles in building and managing multifaceted IT platforms, both are making significant progress in meeting the ACA’s coverage and access goals. However, the advancements and opportunities of SBMs are not as well-known as the challenges state and federal marketplaces have faced. This paper seeks to explore and highlight early developments in states that have implemented the SBM model.

A central feature of the Affordable Care Act (ACA) is the establishment of health insurance marketplaces. The marketplaces offer consumers organized platforms to shop for health insurance coverage, apply for financial assistance, and purchase coverage without any medical underwriting or premium adjustment based on pre-existing conditions. A key objective of the marketplaces is to foster competitive environments in which consumers can choose from a number of affordable and high quality health plans. This issue brief provides a progress report on the evolution of the competitive dynamics of the marketplaces.

The State Health Access Data Assistance Center monitors enrollment in the fifteen state-based marketplaces and posts monthly reports from the states on the SHADAC website. This document provides an overview of the information states are reporting and, where data allow, shows changes between open enrollment period one (OEP1; October 1, 2013 - March 31, 2014) and open enrollment period two (OEP2; November 15, 2014 - February 15, 2015).

As consumers gain familiarity with their health coverage, they are increasingly looking for help selecting plans that align with their financial circumstances and health care needs. In response, policymakers are working to improve the accessibility and transparency of information on key plan features and to develop consumer-friendly tools that make it easier to compare and select health plans. In light of growing interest in how best to support consumer decision-making in the marketplace, this qualitative analysis offers recommendations for improving plan comparison and selection processes. This new report is based on interviews with national consumer assistance experts and navigators in California, Colorado, Florida and Illinois.

The ACA has prompted health plans to increase their use of "narrow networks" of providers as a cost containment strategy. These plans have proven popular on the ACA marketplace because they carry lower premiums. Yet consumers have little information to guide them on the tradeoff between lower premiums and network size when shopping among the various plans offered on the ACA marketplace. Regulators and policymakers also have little information on these networks. New federal requirements for updated, accurate provider directories create an opportunity to significantly improve consumers' ability to make more informed health plan choices. This data brief describes the breadth of the physician networks in plans sold on the state and federal marketplaces.

Since 2010, eight states have negotiated with the federal government to implement Delivery System Reform Incentive Payment (DSRIP) or “DSRIP-like” programs. These programs are a component of Section 1115 demonstrations that incentivizes system transformation and quality improvements in hospitals and other providers serving high volumes of low-income patients. DSRIPs aim to meet strategic goals, based on the Triple Aim principles of better care, improved health, and lower costs by incentivizing reforms that transition away from episodic treatment of disease toward prevention and management of health and wellness among patient populations. This report provides an in-depth cross-state analysis of current DSRIP and DSRIP-like programs. It describes implementation experiences from the federal, state, and provider perspectives.

As states continue to refine the operations of their health insurance exchanges, regardless of the exchange type (state-based exchange, state partnership exchange, or federally facilitated marketplace), it's helpful to compare and contrast operational resources. This chart contains each state's resources and forms for three distinct and fundamentally important areas of exchange operation: applications, appeals, and taxes. With links directly to the states' forms and guides related to these issue areas, this chart serves as a one-stop resource library for those interested in developing new, or revising old, versions of applications, appeals, and tax resources.