The Obama administration on Friday released a batch of rules governing the new, state-based insurance exchanges mandated under the sweeping health care law passed last year.
The proposed regulations lay out standards and processes for individuals and businesses to enroll in insurance plans, guidelines for receiving federal subsidies and guidance on linking the exchanges with Medicaid and the State Children’s Health Insurance Program for a one-stop shopping experience.
They’re the latest in a series of rules being issued by the Department of Health and Human Services that lay out perimeters for how the exchanges should operate, what types of plans can be offered through them and ways they can be used by individuals and businesses seeking coverage.
Officials said a key goal is to make it convenient, simple and easy for Americans to view their insurance options, gain access to any subsidies for which they may be eligible and select a plan. Under the law, everyone must have health insurance or pay a penalty beginning in 2014.
The rules aim to help states set up a single portal where consumers can view all of the insurance options available to them based on their income and family size, said Kathleen Sebelius, secretary of Health and Human Services. The centralized marketplaces should offer a seamless shopping experience, she said.
“This is not a ‘submit your information, and we’ll get back to you’ or ‘call an 800 number and someone will call you eventually,’” Mrs. Sebelius said. “This represents a real time ability to connect consumers with options they are eligible for.”
Those who don’t qualify for Medicaid and yet can’t afford insurance offered through their employer may obtain premium subsidies through the exchanges. A family of four living on $22,350 and $89,400 would be eligible. On average, an estimated 20 million people will get $5,000 in premium tax credits each year, according to the Congressional Budget Office.
But the exchanges would assist more than just those who qualify for subsidies, said Chiquita Brooks-Lasure, director of coverage policy for HHS. Higher-wage earners shopping for a private plan and Medicaid beneficiaries could also obtain information about their own specific options.
“The goal is to make sure people would get the same answer whether they were applying through the Medicaid office or the exchange office,” she said.
States are awaiting somewhat anxiously the full release of rules, since they face a deadline of January 2014 to have the exchanges up and running. However, the deadline is no longer hard and fast after HHS promised more flexibility last month.
Even if states don’t achieve certification by the January 2013 deadline for setting up exchanges, they could still receive “condition approval” if they demonstrated progress. If they still aren’t ready by 2014, and the federal government steps in to run the exchange, states may still apply to assume oversight later on.
HHS also awarded on Friday $185 million to 13 states and the District of Columbia to be used for setting up the exchanges. The agency currently soliciting feedback about the proposed rules.