Establishment of Exchanges and Qualified Health Plans
Newswise — WASHINGTON (July 19, 2011) — Researchers from the Hirsh Health Law and Policy Program at the GW School of Public Health and Health Services have released an analysis of the HHS Proposed Rule related to the Health Benefit Exchanges created by the Affordable Care Act. The newly-proposed rule outlines federal requirements states must meet in order to operate an Exchange, as well as standards related the qualified health plans (QHPs) sold through these Exchanges.
The analysis focuses on three main points. First, the proposed rule provides considerable discretion to states to tailor Exchanges to meet their specific needs. Second, in defining the minimum elements of qualified health plans sold in Exchanges, the proposed rule provides important latitude to insurance issuers. Third, the proposed rule implicitly assumes that entry into the Exchange market by issuers will be strong, qualified health plans serving both individuals and groups will be plentiful, and competition will be fierce. Thus the proposed rule in its current form does not contemplate operating standards for Exchanges in the event that plans’ network capacity falls short of expectations and strategies are needed to assure access by qualified individuals and groups. This last issue, notes Sara Rosenbaum, JD, Harold and Jane Hirsh Professor of Health Policy and a study co-author, has been an important reality in other markets serving subsidized populations and merits a strong focus as Exchange planning proceeds.
The Hirsh Program analysis also summarizes HHS’ proposed rule related to risk adjustment, risk corridors, and reinsurance, released simultaneously. Risk adjustment is an important concept designed to account for adverse risk selection, in which individuals with higher health risks are unevenly distributed across health plans.
To read the full analysis, visit: http://www.gwhealthpolicy.org/files/Hirsh Memo on Exchanges final final md 7.19.11.pdf
An abbreviated version of the analysis is available through Health Reform GPS, a partnership between the Robert Wood Johnson Foundation and the Hirsh Health Law and Policy Program, which charts federal implementation of the Affordable Care Act. http://www.healthreformgps.org/resources/health-insurance-exchanges-update-qualified-health-plans-reinsurance-risk-corridors-and-risk-adjustment/
###
About The Hirsh Health Law and Policy ProgramEstablished in 1997 and endowed by Dr. Harold and Jane Hirsh, the Hirsh Health Law and Policy Program is designed to foster an interdisciplinary approach to the study of health law and its relationship to health policy, health care, and public health. The Hirsh Program is closely affiliated with the various research centers in the Department of Health Policy, and program faculty place a particular emphasis on federal legislative and regulatory law and laws that affect the public’s health and shape the financing, delivery, and quality of health care. The program offers unique educational opportunities in health law and policy for three principal audiences: law students and lawyers; public health degree candidates; and medical and health professions degree candidates and practitioners.
About the George Washington University School of Public Health and Health Services:Established in July 1997, the School of Public Health and Health Services brought together three longstanding university programs in the schools of medicine, business, and education that we have since expanded substantially. Today, more than 1,100 students from nearly every U.S. state and more than 40 nations pursue undergraduate, graduate, and doctoral-level degrees in public health. Our student body is one of the most ethnically diverse among the nation's private schools of public health. http://sphhs.gwumc.edu/
RSS