Health Insurance Exchanges
Health Insurance Exchanges are an important part of health care reform, and for those of us advocating to improve outcomes for children and families, Health Insurance Exchanges are an important aspect of that advocacy. Learn more about Health Insurance Exchanges below and discover how you can insert yourself in the conversations that are happening at the state and local level to advocate for the needs of the children and youth you serve.
Here's how the Kaiser Family Foundation defines a health insurance exchange:
Exchanges are new organizations that will be set up to create a more organized and competitive market for buying health insurance. They will offer a choice of different health plans, certifying plans that participate and providing information to help consumers better understand their options. Beginning in 2014, Exchanges will serve primarily individuals buying insurance on their own and small businesses with up to 100 employees, though states can choose to include larger employers in the future. States are expected to establish Exchanges – which can be a government agency or a non-profit organization – with the federal government stepping in if a state does not set them up. States can create multiple Exchanges, so long as only one serves each geographic area, and can work together to form regional Exchanges. The federal government will offer technical assistance to help states set up Exchanges.
- Provide consumer assistance tools, including a call center and an internet website
- Hold regular public board meetings o include one consumer representative
- Establish a Navigator program -
According to the Affordable Care Act (ACA), Navigators may be community and consumer-focused non-profit groups (at least one); trade, industry, professional associations; commercial fishing industry organizations; ranching and farming organizations; chambers of commerce; unions; partners of the Small Business Administration (SBA); licensed insurance agents and brokers; and other entities capable of carrying out the required duties.
- conduct public education activities to raise awareness of the availability of qualified health plans
- distribute fair and impartial information about enrollment in qualified health plans and the availability of premium tax credits facilitate enrollment in qualified health plans
- provide referrals to an office of health insurance consumer assistance or ombudsman, or any other appropriate state agencies, for any enrollee with a grievance, complaint, or question regarding their health plan
- provide information in a manner that is culturally and linguistically appropriate to the needs of the population served by the Exchange
- ACA offers flexibility to states – the challenge is that the degree of flexibility provided by HHS to states establishing Exchanges could result in drastically different marketplaces across the US.
What you can do:
- See how your state is doing in setting up an Exchange -
- Participate in online conversations at Health Refor(u)m, an online network for health reform implementation. It is an initiative of the National Academy for State Health Policy, funded by the Robert Wood Johnson Foundation.
- Identify the people and organizations that are leading the effort of establishing a state Health Insurance Exchange, and coordinating ACA implementation in your state -
1. Identify the Consumer Advocate group that is helping to plan and execute the
establishment of an Exchange in your state
2. Determine when planning meetings are held and attend those meetings regularly