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Speak Up on the Exchange!

As you know, the federal reform law requires states to have fully functioning exchanges by January 1, 2014. It specifies that the exchanges offer coverage for individuals and small businesses, and that the exchanges be operated by a government agency or non-profit entity. Health plans must adhere to the exchange guidelines in order to offer subsidized coverage through the Exchange. Purchase of insurance through the exchanges will be available for U.S. citizens and legal permanent residents. The exchanges will also contain new consumer protections that health plans must adhere to in order to take advantage of the new market.

While states will be obliged to adhere to those federal requirements, the law leaves a majority of the construction of the exchanges to the states.

Some of these large questions include:
• Should the state establish its own pool or be part of the federal pool?
• Should the exchange be statewide or a regional consortium of neighboring states?
• Should the entity be a public agency, public-private partnership, or a private non-profit organization?
• Should the exchange be a web-portal, like E-Insurance or an active price and coverage negotiator?
• Should a board govern the exchange? If so, how? Make-up? Selection?
• What will be the relationship between the exchange, private insurance and public programs?
• Should Medi-Cal and Healthy Families be a part of the Exchange? If so, should the Exchange be authorized to do Medi-Cal and Healthy Families eligibility determinations and redeterminations?
• Should there be a separate small employer pool or should individuals and small employers buy as part of the same pool?
• Can there be a public option in the exchange?
• How do we maximize participation and outreach?
• How will the Navigator grants operate and who will be eligible for them?
• What will be the roll of brokers? CAA’s?

One of the two exchange bills moving rapidly in the legislature this summer, AB 1602 (Perez) and SB 900 (Alquist & Steinberg), will likely pass this year and become law. It will begin to set the framework for California’s Health Benefits Exchange and include initial answers to many of these key questions.

If you have thoughts on any of these topics, or suggestions for how they might be actualized and implemented, NOW is the time to speak up. Reach out to your legislature, comment on this blog, contact me (cliff @ itup.org), and make your voice heard!

To assist you, be sure to check out our new side-by-side comparison of the Exchange bills.