The establishment of health insurance exchanges is one of the most significant reforms contained in PPACA. Exchanges will transform our nation's private healthcare marketplace for individuals and small businesses buying coverage. Since it is the professional role of health insurance agents and brokers to provide consumers with accurate information about their health coverage options, we believe that exchange participation is a natural fit. However, as health insurance exchanges are created by both the states and federal government, we must ensure that they allow individuals and business owners to utilize traditional agent and broker services. Exchange consumers will need agent and broker access not only during the annual enrollment process, but also to handle their policy service needs on an ongoing basis.
With the re-election of President Obama and the Supreme Court decision to uphold PPACA, it is clear that health reform is here to stay. States were given the opportunity to choose between three different exchange models to help Americans gain access to health insurance coverage. About half the states initially decided to allow the federal government to run their health insurance exchanges, with the remaining half of states split between operating their own, unique state based exchange and partnering with the federal government. No matter what exchange model a state chose, it is clear that exchange implementation will be no easy task. In an attempt to transition the country to this new health reform structure, PPACA provides a role for navigators and assistors. While navigators and assistors are prohibited by law from actually enrolling consumers in health insurance plans, they will serve as a resource for consumers looking to purchase coverage through the exchanges. NAHU has been working with state and federal and policy makers on exchange implementation to ensure that exchange consumers are able to benefit from the services of licensed health insurance agents and brokers, no matter what exchange model the consumer’s state operates under.
Additionally, PPACA creates a separate, unique exchange for small businesses called Small Business Health Options Program (SHOP). Small businesses often find it incredibly challenging to find affordable health insurance for their employees. To make coverage more affordable for small businesses, the SHOP exchange sets up a separate state- based insurance market exclusively for small businesses. The SHOP exchanges which originally we set to open in January 2014 have experienced some delays. In March of 2013, the Department of Health and Human Services announced that components of the SHOP exchanges in states operating under a Federally Facilitated Exchange or a Partnership Exchange would be delayed until January 1, 2015. In 2014, the plan will still offer small employers SHOP coverage through federally facilitated exchanges and partnership programs, but employers would not be able to offer their employees multiple plan choices from multiple carriers and pay one aggregated premium. Instead, small employers will be able to pick from one of many qualified health plan choices for their employees, mirroring what will already be available to employers in the traditional small group marketplace.Here are some of NAHU’s comment letters on exchanges.
State Exchange Decisions
This map by the Henry J. Kaiser Family Foundation details the exchange model chosen by each state.
NAHU’s Recommendations for the State-Based Regulation of Navigators
This principles statement, developed by NAHU’s National Legislative Council and Exchange Working Group outlines NAHU’s recommendations for state regulation of navigators.
NAHU’s White Paper on State Regulation of Navigators
This paper summarizes state regulation of navigators in a health insurance exchange.
NAHU has developed an FAQ document on the FLSA exchange notification to employees.