Published: December, 2010

Diverse Group of Experts Prepares Alternative Options to Complement NAIC Effort

The American Health Benefit Exchange Model Act adopted by the National Association of Insurance Commissioners (NAIC) is an important first step in helping states create health insurance exchanges and reforming health care markets around the country. The National Academy of Social Insurance (NASI) intends to build upon the NAIC’s work in the first product of a blue-ribbon study panel of nonpartisan experts tasked with developing model legislative options for states to use in the design of health insurance exchanges. NASI’s effort aims to provide additional legislative options as states wrestle with a 2014 deadline to design an exchange to fit their particular health care environment.

The goal of the NASI effort is to help states understand the many challenging implementation issues in the Patient Protection and Affordable Care Act (ACA) and the multiplicity of ways of responding. The study panel, co-chaired by Deborah Chollet, Senior Fellow at Mathematica Policy Research and Sara Rosenbaum, Professor of Health Law and Policy and Chair of the Department of Health Policy at the George Washington University School of Public Health and Health Services, is set to release additional legislative options available to states in late January. The two-year project is funded by the Robert Wood Johnson Foundation.

The 21-member study panel brings together experts from a variety of disciplines and philosophical perspectives including academia, government, the insurance industry, employers and consumers. Study panel members formed workgroups on governance, exchange functions and responsibilities, the relationship of the exchanges to the insurance market, and the relationship of the exchanges to Medicaid. Each workgroup has been charged with exploring a continuum of policy options available to states. These options range from the minimum requirements of the Patient Protection and Affordable Care Act as reflected in the NAIC model law, to policy options that enable states to take a more direct role in shaping the insurance market and coordinating the state Medicaid program with the private insurance market.

The NASI study panel is expected to offer states additional legislative options around such vital issues as rules relating to open enrollment, the role of navigators, the use of selective contracting, interaction between the exchange and state departments of insurance and the interplay between the exchange and the state’s Medicaid program.

In addition, the Governance workgroup is preparing an issue paper outlining the key issues states face in choosing any of the four governance structures permitted under the ACA: an existing or new state government agency, a nonprofit entity established by the state, or a multi-state exchange. The issue paper will analyze the suitability of each option, the relationships among state agencies, a state’s comfort in authorizing rulemaking authority, available funding sources, operational flexibilities, management structures, and a state’s desire to balance political independence and accountability. The experiences of two existing exchanges (the Massachusetts Connector and the Utah Health Exchange) were also considered, based on interviews with people involved in the creation of these exchanges.

The study panel, which met formally for the first time on September 30th, has an ambitious timetable. It plans to release its first report in January 2011, anticipating states’ legislative calendars. A series of policy briefs will synthesize the panel’s discussions and design issues critical to the success of an exchange.

The study panel benefits from regular consultation with staff at the National Governors Association (NGA), the National Conference of State Legislatures (NCSL), and the NAIC.

For more information about NASI’s Health Insurance Exchange Study Panel, please contact Sabiha Zainulbhai, Health Policy Assistant at or Lee Goldberg, Health Policy Director at Both can be reached by telephone at 202-452-8097.

The National Academy of Social Insurance (NASI) is a nonprofit, nonpartisan organization made up of the nation’s leading experts on social insurance. Its mission is to promote understanding of how social insurance contributes to economic security and a vibrant economy.

Study Panel on State Health Insurance Exchanges

Deborah Chollet (Co-Chair), Senior Fellow, Mathematica Policy Research

Sara Rosenbaum (Co-Chair), Harold and Jane Hirsh Professor of Health Law and Policy and Chair of the Department of Health Policy, George Washington University

Lawrence Atkins, Executive Director, U.S. Public Policy, Merck & Company

Gary Claxton, Vice President, Kaiser Family Foundation

Brian Coyne, Senior Vice President, Federal Government Relations, Amerigroup Corporation

Rick Curtis, President, Institute for Health Policy Solutions

Anne Dunkelberg, Associate Director, Center for Public Policy Priorities

Jonathan Gruber, Professor of Economics, Massachusetts Institute of Technology

Alvin Headen, Associate Professor of Economics, North Carolina State University

Timothy Jost, Robert L. Willett Family Professor of Law Washington and Lee University

Renée M. Landers, Professor of Law and Faculty Director, Health and Biomedical Law Concentration, Suffolk University Law School

Amy Lischko, Assistant Professor, Public Health and Community Medicine, Tufts University School of Medicine

Richard P. Nathan, Director Emeritus, Nelson A. Rockefeller Institute of Government

Len Nichols, Director, Health Policy Program, George Mason University

Alice Rosenblatt, Health Actuary

Dean Rosen, Partner, Mehlman Vogel Castagnetti, Inc.

David R. Riemer, Director, Community Advocates Public Policy Institute

Murray Ross, Vice President and Director, Kaiser Foundation Health Plan & Kaiser Permanente, Institute for Health Policy

Paul Van de Water, Senior Fellow, Center on Budget and Policy Priorities

Alan Weil, Executive Director, National Academy for State Health Policy

Tim Westmoreland, Visiting Professor of Law & Research Professor, Georgetown University

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