KC Health Care Reform

Long-awaited guidance around a key element of health care reform was released on Monday, July 11. The Department of Health and Human Services issued a series of proposed regulations under health care reform including how states can establish exchanges to buy insurance.

States can have some flexibility when it comes to setting up their health insurance exchanges, according to the proposed regulations. Up to this point, many states have struggled with exchange planning, threatening their ability to meet a 2013 deadline, which would put them at risk for the government to run their state exchanges.

For states that aren’t quite ready to meet the January 1, 2013, deadline, the Department of Health and Human Services may issue “conditional approval,” extending the timeline for states wanting to establish health exchanges.

The 244-page regulation also addresses the standards for establishing exchanges and the certification process for health plans to sell on the exchanges. But many critical components were left unaddressed, including what benefits insurers will be required to cover.

So far, 12 states have passed bills that establish exchanges or expressed their intention to establish one, but other states continue to oppose implementation..

The Obama administration has started preparations for a federal fallback for those states that do not set up their own exchanges. It would take one year to transition a federally-administered exchange to a state-based one.

Missouri and its Senate Interim Committee continue to evaluate Missouri’s options for a state-based health insurance exchange.