Friday, December 21, 2012

Health Insurance Exchanges Come into Focus Amidst the Holiday Fog

The Affordable Care Act (ACA) provided for the creation of health insurance exchanges designed to allow consumers and small businesses to visit an online marketplace to compare and purchase insurance plans. Under the law, states can choose to operate their own exchange or, if they are unable or unwilling, a federal exchange will be available for patients to compare plans.

Following last week’s deadline for states to declare their intent to participate, the Obama Administration has now approved 11 state exchanges and one state/federal partnership exchange (Delaware). These exchanges are expected to be operational in time to enroll customers beginning in fall of 2013. Although states can choose to establish exchanges at a later date, it is unlikely they will be able to open in time to meet the January 2014 deadline—any states not meeting the deadline will be served by the federal exchange until their exchange is operational.

INTERACTIVE: For a great overview of which states are planning to participate in the exchanges, visit the Commonwealth Fund’s interactive exchange map.

For health centers, patients with income levels between 133% and 400% FPL eligible to be insured via the exchanges will no doubt become a substantial portion of the new payer mix.  Fortunately, the ACA requires insurers participating in the exchanges to pay health centers their Medicaid PPS rate.  This should help health centers continue to provide the quality, comprehensive care for which they have come to be known.

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