What exactly IS a Health Insurance Exchange and what are Arizona’s plans?

November 4th, 2011 by Laura Nelson Leave a reply »

Although there continues to be controversy and legal battles about aspects of the federal health care reform legislation, it currently is the “law of the land” and Arizona must consider what is in the best interest of our state.  As part of the Affordable Care Act (ACA), all states must implement a Health Insurance Exchange on January 1, 2014 to assist with the purchase and sale of health insurance for individuals and small businesses.  The exchanges are meant to create a competitive private health insurance market and will provide millions of Americans and small businesses with “one-stop shopping” for affordable coverage. 

As it is designed now, tax credits will be available for many individuals, families and businesses to help them purchase coverage in the Exchanges. This subsidized health insurance option will be based on a sliding scale depending on a person’s income. The subsidies are for those people between 133% and 400% of the Federal Poverty Level (FPL)…recall that Medicaid eligibility will increase to 133% of the FPL. At the lower end of the income scale, the subsidies are as high as 93% of the premium cost for the insurance.  Insurers cannot deny coverage for someone due to a pre-existing medical condition.    The plans offered in the Exchanges will be required to provide at least a basic level of comprehensive benefits that include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and new born care
  • Mental health and substance use disorder services, including behavioral health services
  • Prescription drugs
  • Rehab and habilitative services and devices
  • Lab services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including vision and dental care

Health insurance exchanges will open up private health insurance to many people in Arizona who are currently not eligible for Medicaid, but have been unable to afford insurance. Insurers will not be able to reject them based on medical condition or exclude coverage for their mental illness or other physical illness. We can expect hundreds of thousands of Arizona citizens to become newly eligible and enrolled in Medicaid or enrolled in the insurance exchange. (We can also assume that many of these individuals will have mental health and/or substance abuse treatment needs!)

 States have the option of establishing their own exchanges, but those that don’t will be required to use the program put in place by the federal government.  Arizona strongly believes that it will be better served by designing and running its own Exchange than by allowing the federal government to impose its model on us. So, to that end, Arizona recently applied for a second grant (not yet approved) to further plan, design and develop the Arizona Health Insurance Exchange.  The funds will secure the IT infrastructure necessary for a user-friendly website that is fully integrated with Arizona’s existing Health-e-Arizona system. The funds will also assist in developing the insurance plan certification, recertification, decertification processes to ensure there are qualified plans available in Arizona.  There will be lots of work needed to educate and outreach to the public as well. I am pleased to be a member of the Arizona Health Insurance Exchange Steering Committee assisting in this work.

 For more information:

http://www.azgovernor.gov/hix/documents/QuickLinks/HIXOverview.pdf

http://www.azahcccs.gov/tribal/Downloads/consultations/meetings/2011/Oct12/Presentation_ArizonaHealthInsuranceExchange_MedicaidExpansion.pdf

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20 comments

  1. Guy myers says:

    Hey There Bhsblog,
    Thanks for that, One of the linchpins of healthcare reform is the creation of insurance exchanges. Those markets will be heavily regulated, both in terms of rates and mandated coverage levels. Insurers will not be allowed to discriminate based on gender or pre-existing conditions. Moreover, many low- and middle-income individuals and families will be eligible for subsidies, which will cover some or all of the premium expense. In addition, small employers will also be allowed to participate.
    Regards

  2. Hi Laura

    Thank God for these Health Insurance Exchanges. It has been an absolute shame for the US not to be able to provide health care to those who need it the most i.e. the poor, unemployed and low paid.

    I live in England where we enjoy free health care. While it may not be the best in the world it is good health care. Nobody should be discounted from proper health care.

  3. Alex Simring says:

    Health care in USA seems totally different to Australia – I can’t believe how little medical cover is offered to those without private health insurance.

  4. Thanks for sharing your views on the Health Insurance Exchange. Our country is split over this, hopefully we can work it all out.

    It appears that Arizona is on the front lines here!

  5. Sandy Bell says:

    I think our country will always be split on this topic, but it is essential that people in our country get access to some level of health care. I am a doctor myself and see many patients that simply cannot afford to do any level of proper care due to poor financial status. At least it’s a step in the right direction.

  6. I like it when individuals come together and share ideas. Great site, keep it up!

  7. this is a great health article. it’s good to know that there is a voice out there to help me with my health. keep up the good work, and don’t quit.

  8. Valene Spanski says:

    I think this may be true. Sad to say, it makes me laugh!

  9. ammo cans says:

    Great post! I’ve got an idea here. Thanks for sharing this information. It will really help.

  10. to some level of health care. I am a doctor myself and see many patients that simply cannot afford to do any level of proper care due to poor financial status. At least it’s a step in the right direction.

  11. Great Post. Thanks for sharing the health insurance exchange plans details..

  12. Thanks for sharing, this is a great health article

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  14. Roger Hoo says:

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  15. Hi you . The quality of health care in the United States so much more than my country . Hopefully one day there will be improvements in the health sector . Thanks for your article

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  17. Chuot game says:

    Great Post. Thanks for sharing the health insurance exchange plans details..
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  18. Chuot gia re says:

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    Thanks for sharing!

  19. Nguyen Vu says:

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