A model that creates a framework for the purchase and sale of qualified health plans in the individual market through health exchanges is moving toward full adoption by state insurance regulators.
A draft of the American Health Benefit Exchange Act was adopted by a subgroup of the Health Insurance and Managed Care “B” Committee chaired by Michael McRaith, Illinois insurance director.
The model provides for the establishment of a “Small Business Health Options Program (SHOP Exchange) to assist qualified small employers in facilitating the enrollment of their employees in qualified health plans offered in the small group market.” The model seeks to provide a transparent marketplace, consumer education and to assist individuals with access to programs, tax credits and subsidies.
The model was advanced on the condition that a drafting note in Section 10 would receive additional consideration. It now goes to the “B” Committee on Nov. 22 before proceeding to the full executive committee and plenary of the National Association of Insurance Commissioners, Kansas City, Mo. Comments are being received through Nov. 19.
The drafting note that was the focus of much of the discussion during the subcommittee review considered how states should treat benefits that exceed federal requirements for qualified health plans. States were also warned of the potential for adverse selection, when the sick stay with a plan and the healthy opt out, if there are inconsistent benefits inside and outside of an exchange. One drafting note option suggests that states should consider a “’mandated offer’ provision under which carriers must also offer the option to purchase coverage providing all benefits that would otherwise be required by State law.”
McRaith commented that the drafting note should not be too prescriptive. Later in the discussion, a representative for Autism Speaks, New York, cautioned states that the language was “far too prescriptive” and raised the concern that it would have a negative impact on Americans with significant disabilities because of the potential to loosen mandates.
Joan Gardiner of Blue Cross/Blue Shield, Chicago, said that BC/BS was supportive of exchanges and was concerned that language that was too prescriptive might impede them getting up and running.