« January 2013 Issue

Full Steam Ahead on Exchanges

One year before key coverage expansions in the Affordable Care Act (ACA) take effect, consumer health advocates and state and federal officials across the country have long to-do lists to prepare for 2014. Among the largest items on each state's list is setting up a Health Insurance Exchange, an online marketplace where people can buy insurance.

Seventeen states and the District of Columbia will implement a state-based Exchange -- meaning the state government will take responsibility for ensuring the marketplace runs well and is consumer friendly. Advocates in these states have been appointed to multiple task forces, advisory committees and Exchange boards because of their policy expertise and ability to bring the consumer voice to the conversation.

From working on how people will enroll in health insurance and ensuring consumers can easily make comparisons between health plans to providing input on the technical aspects of the Exchange, including helping set high standards for insurance plans sold in the Exchange and ensuring Exchange and Medicaid enrollment can work together seamlessly, a few advocates in each state have to be knowledgeable about a broad range of topics. These advocates have drawn on years of policy work and state-level reform efforts to make meaningful contributions to the development of Exchanges. The learning community created through the Consumer Voices for Coverage and Affordable Care Act Implementation Fund programs have been a vital part of the process for advocates working to implement state-based Exchanges.

"These states are making decisions no one has had to make before," said Christine Barber, a Community Catalyst senior policy analyst. "We bring the advocates together to help them share early best practices and common struggles."

While each state faces different challenges, sharing resources and knowledge with other states has helped build expertise on the host of issues advocates working on a state-based Exchange have weighed-in on.

The 32 states not running their own Exchange will either partner with the federal government, or have the federal government facilitate an Exchange within their state. (States have until February 15 to decide between a partnership Exchange and federally facilitated Exchange.) States with partnership and federally facilitated Exchanges will continue to have significant input on regulatory decisions; however, states that choose a partnership will have more say in decisions about the health plans accepted in the Exchange.

The mechanism for consumer feedback, including consumer participation in Exchange governance, is a big challenge for states working on federally facilitated and partnership Exchanges because the work is happening both in the state and in Washington, D.C. Advocate involvement at both the state and federal levels continues to be important to ensure the consumer voice is heard amongst the powerful interests already at the table. The varied state environments have also presented challenges for advocates to navigate.

"Because of the political environment in some states, it's important for advocates to be seen as the ‘go-to' resource for consumer input and information about what's happening on the ground," said Barber. "Some advocates are working directly with the federal government, while others are working to bring a group of stakeholders together with state and federal officials."

Regardless of the type of Exchange a state is running, feedback from advocates will continue to be essential in ensuring Exchanges work for consumers. Outreach to people likely to enroll in Exchanges, including public education and marketing campaigns, will begin late this summer and enrollment will start in October.

"There's a lot of activity in every state right now," said Barber. "Most people finally realize this is the law of the land, and it's time to get moving. This is the year Exchanges, and all the work that's been put into them, start becoming real."