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New Health Insurance Exchanges Should be Independent

  • Published: 2010-09-30 : Author: Commonwealth Fund
  • Synopsis: New report addresses difficult issues for design of exchanges that will be key to effectiveness of the Affordable Care Act.

New report addresses difficult issues for design of exchanges that will be key to effectiveness of the Affordable Care Act.

A new report from The Commonwealth Fund provides recommendations for state and federal policymakers as they design and implement the new health insurance exchanges which are a key element of the Patient Protection and Affordable Care Act (ACA). The state-based exchanges, to be set up by states and the federal government to provide a health insurance marketplace with subsidized health insurance for small businesses and individuals without employer or public coverage, will play a major role in enhancing many Americans' access to health insurance coverage when they are fully implemented in 2014.

The report by Timothy Stoltzfus Jost, Professor of Law at the Washington and Lee University School of Law, Health Insurance Exchanges and the Affordable Care Act: Eight Difficult Issues, examines issues that policymakers will grapple with as they work towards implementing the exchanges, and provides detailed recommendations to improve affordability and access to coverage purchased through the exchanges. These include how exchanges should be set up and governed; how they can avoid adverse selection or having a disproportionately large share of high-cost enrollees, leading to un-affordable premiums within the exchange and how to reduce administrative costs.

The author's recommendations include:


Adverse Selection

Exchanges and Large-Group and Self-Insured Plans

Making Exchanges Work for Employers

The Regulatory Role of Exchanges

Exchanges as Sources of Descriptive and Evaluative Information

Exchanges and Public Subsidy Determination

Administrative Costs and Funding of the Exchange

The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.

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