Creating a Roadmap for State Health Insurance Exchanges

Dates of Project: September 2010 to August 2012

Field of Work: Helping states implement health insurance exchanges

Problem Synopsis: The federal Affordable Care Act requires each state to establish health insurance exchanges by 2014, or use a federally-facilitated exchange. The states face substantial implementation decisions in a short time frame in order to meet these requirements.

Synopsis of the Work: The National Academy of Social Insurance convened a study panel of 21 health policy and insurance experts to develop legislative options for states to use in designing their exchanges. The academy also commissioned reports on issues related to the implementation of health care reform by the states.

Key Results

  • Published a legislative toolkit, Designing an Exchange: A Toolkit for State Policymakers, with model legislative language and analysis of key issues in implementing exchanges.
  • Produced and disseminated six in-depth issue briefs for policy-makers on exchange design, including:
    • Governance issues: Governance Issues for Health Insurance Exchanges
    • Active Purchasing: Active Purchasing for Health Insurance Exchanges: An Analysis of the Options
    • Federally-facilitated exchanges: Federally-Facilitated Exchanges and the Continuum of State Options
    • Relationship building between Medicaid, exchanges, and the insurance market: Building a Relationship between Medicaid, the Exchange and the Individual Insurance Market
    • Plan management: Plan Management: Issues for State, Partnership and Federally Facilitated Health Insurance Exchanges
    • Technology infrastructure: Establishing the Technology Infrastructure for Health Insurance Exchanges Under the Affordable Care Act: Initial Observations from the 'Early Innovator' and Advanced Implementation States

"The most important thing was that it gave state policy-makers an easy to use roadmap on exchanges," Project Director Lee Goldberg, JD, MA said.

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"Designing an Exchange: A Toolkit for State Policymakers" provides easy roadmap for setting up an exchange.