Whither Health Insurance Exchanges Under The Affordable Care Act? Active Purchasing Versus Passive Marketplaces

The health insurance exchange, the organizational innovation of the Affordable Care Act (ACA), is here to stay. The principle of consumer choice among private health plans, with financial subsidies for low-income households, is now firmly entrenched. The Supreme Court has ruled that low-income subsidies are constitutional and hence that the exchanges can operate effectively in all 50 states. As Republicans become convinced that full repeal is infeasible, many will discover that the exchange structure fits their values and policy preferences. Many Democrats will come to recognize that this model has worked well in employment-based insurance systems, in Medicare Part D, and Medicare Advantage, and in many state Medicaid programs. The health insurance exchange has the aura of a policy consensus underneath the political fray. But What Is A Health Insurance Exchange? 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. In this marketplace model, the role of the exchange is to allow for the broadest variety of health plans and products, with the hope that potential enrollees would find the best fit for their needs. It facilitates consumer comparisons of premiums and cost sharing by having plans publish desc...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Following the ACA Insurance and Coverage Medicaid and CHIP Medicare Covered California Denver Federal marketplaces Los Angeles Miami State exchanges Source Type: blogs