The U.S. Department of Health and Human Services recently revamped its official health reform websites (healthcare.gov and cuidadodesalud.gov), and released several new resources for educating the public about the health insurance marketplaces. Also known as exchanges, the marketplaces will open for enrollment in October and new plans and benefits will begin as early as January 2014. Several great new resources are:
New regulations and recommendations
An important part of implementing the Affordable Care Act is the federal rulemaking process, in which executive agencies issue guidance and invite public comment on the details of how the law will work. In the months since the November elections, a number of new regulations have been issued by the departments of Health and Human Services, Labor and Treasury. For brief explanations of each rule, to see other rules recently released and to learn more about the rulemaking process, visit our ACA Implementation page at http://www.apha.org/advocacy/Health+Reform/implementation/.
New “streamlined applications for health insurance”
Also recently released for public review are drafts of new streamlined applications for health insurance, which are intended to be “single points of entry” to various coverage options. The applications are meant to allow people to purchase private insurance in the individual or small business marketplaces, and at the same time to assess their eligibility for assistance through Medicaid, the Children’s Health Insurance Program or the advanced payment of tax credits — subsidies to purchase coverage in the Marketplaces. The Centers for Medicare and Medicaid Services is inviting public comment on the individual, small business owner and small business employee applications. To demonstrate the user experience, CMS has posted two videos of the application being completed, one by an individual and one by a family of three.
State decisions on coverage expansions, marketplaces and essential benefits
While the federal government has been busy issuing regulations, resources and more over the past several months, the states have had some big decisions to make.
Last summer the Supreme Court upheld the Medicaid expansion but restricted the federal government from penalizing states that don’t expand their programs. The states that do opt in will receive generous federal funding to expand eligibility to nearly all residents with incomes up to 133 percent of the federal poverty level, starting in January 2014. As of Feb. 9, 24 states will expand or are likely to, 20 won’t expand or are not likely to, and seven are still undecided. To track the status of your state, you can go to the following websites:
Insurance marketplace design:
States have several options for setting up the new health insurance marketplaces, also known as “exchanges”: they can run their own state-based marketplace; opt for a state-federal partnership or largely opt out and request a federally-facilitated marketplace. States had until Dec. 14 to choose a state-based model; 17 states and the District of Columbia are doing this. In January, $1.5 billion in new grants went to 11 states working to establish their exchanges. Feb. 15 is the deadline for states to choose a partnership model; seven states have done so as of Feb. 8. So far, 26 states will default to federally-facilitated marketplaces, but this number may change as states finalize their decisions and HHS reviews their plans. The Kaiser Family Foundation is tracking this information at http://statehealthfacts.kff.org/comparetable.jsp?ind=962&cat=17&sub=205&yr=1&typ=5#notes-1.
Essential health benefit “benchmark” plans:
Regardless of what type of marketplace a state chooses, each state has also had to choose one of several types of insurance plan to indicate to insurers the “benchmark” for required coverage of ten categories of essential health benefits. States had until Dec. 26 to choose their benchmark or default to the benchmark plan by the federal government. Kaiser Family Foundation has more information on EHB and the states’ decisions at: http://www.kff.org/healthreform/quicktake_essential_health_benefits.cfm