Lee Goldberg, National Academy of Social Insurance
March 23rd, 2012 will mark the second anniversary of the signing of the Patient Protection and Affordable Care Act (ACA). This legislation represents one of the largest and most comprehensive reforms to the American health care system since the enactment of Medicare and Medicaid in 1965. The ACA seeks to extend coverage to roughly 50 million uninsured Americans, slowing down the growth in the cost of health care, and improving the quality of care health care by changing the delivery system.
The ACA would achieve these goals by eliminating the ability for insurance companies to reject a patient due to pre-existing conditions, allowing children to remain on their parents’ health insurance until age 26 and expanding the eligibility of Medicaid for millions of Americans. Additionally, the ACA calls for the creation of state-based health insurance exchanges that will increase the competitiveness and transparency of the individual and small group market for insurance. These exchanges will also provide subsidies to individuals and families to purchase health insurance. If exchanges are successful, they will be a significant help to individuals and small businesses looking to purchase coverage.
Since early 2011, with funding from the Robert Wood Johnson Foundation, an expert NASI study panel released several reports examining exchange design and implementation issues.
Just two weeks before the second anniversary of the passage of the ACA, HHS released the final rule on guidelines for exchanges. Secretary Kathleen Sebelius emphasized the flexibility states will have in designing exchanges. Tim Jost, law professor at Washington & Lee and a member of the health insurance exchange study panel, summarizes the final rule on the Health Affairsblog, and George Washington University’s Health Reform GPS website provides useful information on key developments in exchange regulations. While many provisions in the ACA have yet to take effect, many states have begun to build the basic framework of the exchanges.
NASI will continue to study the upcoming challenges policymakers will face in implementing exchanges. Of two upcoming reports, one will focus on plan management in exchanges and the other will focus on establishing information technology infrastructure in exchanges.