HHS Secretary to Announce Long-Awaited Insurance Exchange Regs Today

February 23, 2017


Today, state governments that have not yet made the decision to embrace or shun health insurance exchanges will finally receive more information, as the Department of Health and Human Services (HHS) has planned to release more data on how these insurance marketplaces will function.

So far, few details have been released on this part of healthcare reform, despite the fact that the creation of the exchanges is a critical transitional step. This is leaving many state legislatures adrift, as they face a deadline of January 1, 2013 to decide whether or not to participate in the program. Those states which embrace exchanges will also have to create rules, guidelines, and information technology systems essentially from scratch.

The impending news from the HHS, then, is crucial. Krista Drobac, the health director at the National Governors Association said the information was vital in order to know what was feasible between now and that looming deadline, less than two years away.

If all goes according to plan, later today, U.S. Health and Human Services Secretary Kathleen Sebelius will make the announcement of the base structure for insurance exchanges from a hardware store somewhere in the Washington, D.C. area.

What’s the Point of Exchanges?

A vital part of the Obama administrations healthcare overhaul program, these insurance exchanges are meant to provide easy access to an entire marketplace of insurance plans, as well as to allow uninsured people and small businesses to form coalitions in order to negotiate for cheaper health insurance rates. States can choose to create their own exchanges, combine efforts with another state to share infrastructure and information, or opt out of the system altogether. In the latter case, an exchange would then be formed by the HHS itself.

So far, however, HHS has not provided any specifics about how the federally created exchanges would look, and the lack of information as added to the unease many governors and state legislatures – especially those in more conservative states – have about committing to the program. Most Republican-run states reject the idea of supporting the reforms they derisively refer to as “Obamacare,” but they still have to face the likelihood of opening their state healthcare systems to a greater amount of scrutiny from the federal government if they opt out of creating exchanges of their own.

HHS isn’t the only federal agency not sharing information. All the other agencies involved have been equally silent about the content and timing of the forthcoming regulations, but it’s expected that the content will include eligibility and enrollment requirements, information on tax credits, and how Medicaid will fit into the new system. As well, detailed guidelines on how the exchanges should manage risk adjustment are expected to be released, as this is a key factor in order to equalize consideration of patients with widely varying medical needs.

In a recent blog post that appeared in the Huffington Post Sebelius gave a preview of today’s planned announcement which said that the exchanges would share three core features:

  1. They will be “one-stop shops” for all insurance needs.
  2. They will guarantee that competition between insurance companies is based on price and quality.
  3. They will ensure that the public has easy access to basic healthcare coverage.

Sebelius also pointed out that members of Congress already get their own health insurance this way, and likened buying insurance under the new system to buying home appliances or airline tickets.

Let’s hope her announcement supports this, because right now, only ten states are completely on board with the concept of exchanges, and are actively working toward their creation, while two – Florida and Louisiana – have said they will not participate in the program.