Recent research discovers new health care reform marketplaces will need significant coordination

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Health Care ReformA new study has found that the success of state insurance exchanges will depend on agencies working together.

As the different states throughout the country choose whether they will be creating and running their own insurance exchanges according to the changes required by the health care reform under the Affordable Care Act (ACA), or whether they will have the federal government do it for them, the results of new research from the National Academy of Social Insurance (NASI) and Georgetown University has shown that managing and certifying the plans within it will require a much larger amount of coordination between the federal government and state agencies.

The exchanges have to make sure plans meet quality standards, comply with protections for consumers, and maintain oversight.

These activities to keep up with the regulations from the ACA are known as “plan management” as a whole. The report on the study was the first to look into the ways in which the federal and state regulators are currently performing these tasks, and to examine how they might be altered when the health care reform changes are put into place.

The report was entitled “Plan Management: Issues for State, Partnership and Federally Facilitated Health Insurance Exchanges”.

The activities that were examined included verifying that a certain plan was in good standing, reviewing the benefits and rates, assessing the network adequacy, improving overall and specific quality, regulation of the marketing practices, and conducting compliance monitoring on an ongoing basis.

According to one of the authors of the study, Sabrina Corlette, who is also a research professor at the Center on Health Insurance Reforms, “We found that the ACA’s requirements for plan management in some cases expand on what states currently do to regulate insurance, but in other cases call for a paradigm shift in how state regulators approach their role.”

The report pointed out that being able to achieve plan management increases in its complexity among the states where the federal government will be running the health care reform exchange, though it should be noted that the responsible federal agency (CMS or Medicaid Services and Centers for Medicare) already has a significant amount of experiencing through the Medicare Advantage program for private plan management.


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