Today I spent the day with a couple hundred health care stakeholders in Chicago at the U.S. Department of Health and Human Services (HHS) regional forum on implementation of the Affordable Care Act (ACA). The day was an opportunity to learn from HHS, share updates, ask questions, and hear from other states in the Midwest on their processes for implementation.
Exchange discussion started the day. The Exchange is one of the key functions of health care reform. It provides a new marketplace for individuals and small businesses (those who do not already have access to affordable coverage) to purchase private insurance in an accessible online market. Premium tax credits will be available to families at lower incomes to help them purchase coverage. States have been granted much flexibility to operate their own state-based Exchange, but have to show their intent and preparedness to do so by November 16th, 2012, in order to be certified by HHS on January 1, 2013, and open for enrollment in October 2013.
It is the preference of WCCF, and the Access Network of many WI health care stakeholders, that Wisconsin set up its own Exchange. However, the ACA planned and the federal government allowed for two options in states not yet ready or willing to operate their own Exchange, a partnership state-federal Exchange or a Federally Facilitated Exchange (FFE). Dialogues like today’s meeting with HHS are the beginning of continued opportunity for stakeholders to engage in the process of setting up partnership or FFE. In fact, Wisconsin’s Insurance Commissioner, Ted Nickel, will be participating in an advisory body on partnership and FFE development. However, Wisconsin officials maintain that the state will not determine if it will participate in a state-based, partnership, or FFE until after the November elections.
Related to exchange development, today’s meeting turned to Essential Health Benefits (EHBs). These are the ten categories of benefits outlined in the law that must be included in all individual and small group plans both inside and outside the exchange. This creates a standard of benefits among plans, but also provides flexibility to states. States will have until the end of September to choose a benchmark plan to define the EHB that represents typical coverage in the state insurance marketplace, and states must supplement any missing benefits from the ACA outlined ten categories.
If a state doesn’t act, the default EHB is the largest small group plan by enrollment in the state, and the federal government will take public comment on the selected benchmark. Wisconsin has many state mandated benefits that would be covered under the default benchmark plan. This benchmark plan will be in place in 2014 and 2015, to create a stable marketplace in the beginning of exchange implementation.
The meeting turned to discussion of a topic common to WCCF blog readers – the Medicaid expansion in the ACA, otherwise known as filling the gap in BadgerCare Plus.
The consumer experience was also critical to the later part of the discussion. Key to the success of the exchange is a single, streamlined application. HHS is currently working on that application, taking feedback, and undergoing consumer testing. They will also be engaged in stakeholder engagement, as mentioned above. WCCF will continue to participate and convene stakeholders in Wisconsin to engage with HHS and the state around all aspects of implementation of the ACA.
Sara Eskrich
