Under the health overhaul, every state will have a new health insurance marketplace called an “exchange,” which launch in 2014. Often described as state-based “Expedias” for health insurance, the exchanges will serve as online hubs for individuals and small businesses to compare and purchase health insurance plans. Low- and middle-income Americans will also be able to use new tax subsidies on the exchange, meant to make health coverage more affordable.
Approximately 24 million Americans will eventually purchase their health insurance through these new exchanges, according to estimates from the non-partisan Congressional Budget Office. If a state does not set up its own exchange, the federal government will step in and do the job, ensuring each state has its own market.
The Affordable Care Act, passed last March, laid out some basic exchange guidelines, which detailed who would be eligible to use the marketplace and what type of coverage insurance companies would be required to sell.
But it also left many questions: who will be authorized to sell health insurance on the exchange? What benefits will health plans have to cover? And, if states don’t set up their own marketplace, what would a federally run exchange look like?
“If we don’t get this right, we could mess up the insurance market rather than improve it,” said Judy Waxman, vice president for health at the National Women’s Law Center, a consumer advocacy group. “We really feel this is so new to most people, it’s worth laying the right ground rules.”
America’s Health Insurance Plans, which lobbies for the insurance industry, has pushed the Obama administration to leave much of the regulation to the states, which have traditionally overseen insurance market functions. More than anything though, AHIP wants more final rules from the administration, so its members can know what to plan for.
“We need to understand what the rules are,” AHIP President Karen Ignagni said in a recent interview. “It takes a great deal to make sure you’re ready. That’s one of the reasons we’ve telegraphed such a sense of urgency in our comments.”
Less obvious health industry groups also have a big interest in how the Obama administration sets the rules.
That includes pharmacy chain CVS Caremark, which has 7,200 drug stores across the country. The company has petitioned the Obama administration for rules that would allow its employees, such as pharmacists and nurse practitioners, help consumers navigate the exchange and purchase health insurance.