State-Based Marketplaces 2.0 – Part 1: The Coming Expansion in Access, Affordability, and Value

CONCLUSION: LOCAL SOLUTIONS ADVANCING MEANINGFUL REFORM The ACA gives states the flexibility to implement SBMs and encourage private sector participation. The federal government is responsible for establishing coverage standards, financing subsidies, and operating the HealthCare.gov platform. But it faces some challenges when it comes to innovating. By contrast, states can be nimble. They can tailor program offerings to meet market demands and dynamics. Factors influencing program design could also include the state’s urban/rural mix, the size of its employer base, the payer mix, social determinants of health, demographics, and cultural attributes. This ability to accommodate market preferences and other factors validates the federalist approach that the ACA takes in granting SBM program design to the states. This flexibility avoids the “one-size-fits-all” approach incorporated within the federally run marketplace. By tailoring their SBMs to local circumstances, the states have become vital engines of experimentation and innovation for advancing the overall effectiveness of the nation’s healthcare marketplaces. With enhanced program design and expansion to more states, along with support from the Build Back Better Act, SBMs are well-positioned to serve as a catalyst for meaningful healthcare reform. Not all progress is revolutionary. As SBMs have demonstrated, evolutionary improvements in benefit design, enrollee engagement, risk management, and outreach e...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Health Policy Obamacare Affordable Care Affordable Care Act American Rescue Plan Biden-Obama Build Back Better Act David W. Johnson Joe Biden Rosmarie Day State-based marketplaces Source Type: blogs