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Recommendations for Exchange Implemention

Opening its doors on January 1, 2014, the California Health Benefit Exchange will offer affordable coverage to millions of uninsured and currently under-insured individuals, as well as to small- and eventually to mid-sized employers. Premium subsidies in the form of refundable tax credits will be available to those with incomes between 133% and 400% of the Federal Poverty Level (FPL) and to small, low wage employers. According to the ULCA Center for Health Policy Research, more than 3.2 million Californians will be eligible for the premium subsidies in the Exchange, over two-thirds of whom are currently uninsured.

Over the past three months, ITUP has convened a California Health Benefit Exchange Workgroup comprised of public and private payers, hospitals, community clinics, academics and advocates to discuss the major questions concerning California’s Exchange and to develop recommendations and strategies to help ensure successful Exchange implementation.

In addition to a series of engaging discussions, the workgroup recently produced this Exchange White Paper. Among others, it outlines the basic parameters established by the federal reform and state legislation, summarizes the significant implementation issues at stake, and offers descriptions of various stakeholders’ positions.

Also in the paper, we make specific policy recommendations regarding the next stage of Exchange implementation. Here are a few:

  • The Exchange should be a strong purchaser, consumer advocate, and problem solver;
  • The Exchange should be a large portal to entry for Californians to access all health coverage programs and a link to other assistance programs, but be one of many doors in a “no wrong door” landscape;
  • The Exchange’s role as an active purchaser of coverage can drive delivery reform;
  • The Exchange should selectively contract for the most cost-effective, high-value plans, but be mindful to ensure meaningful choice for consumers;
  • The Exchange will need to go beyond the requirements of federal and state law to guard against adverse risk selection and the premium death spiral that could result if the Exchange becomes a pool for only the highest-cost consumers;
  • The state will need to undergo aggressive outreach and education tactics to ensure proper Exchange utilization and public understanding of the Exchange’s function;
  • There should be a variety of Navigators since they may be the best form of outreach and enrollment for lower income individual. Some must be bilingual, know the local healthcare environment, and be culturally competent;
  • For employers to participate, the Exchange must be easy to navigate, have consolidated billing practices, and offer a relatively robust choice of plans;
  • Eligibility rules for other public programs should be consistent with the Exchange;
  • Enrollment in Exchange coverage should be continuous for twelve months; and
  • The Exchange’s web portal should provide information on the benefits, costs, quality, and provider network in a user-friendly fashion.

For more Exchange analysis and to read all of the Workgroup’s suggestions, be sure to read the White Paper.