ACA Title I, Sec. 1321. State flexibility in operation and enforcement of Exchanges and related requirements: “Good” – Provides option for state to operate insurance “exchange” including standards and protection from federal preemption. This section of the ACA provides for states to operate an insurance exchange and that the Secretary of HHS will promulgate standards and a process for becoming an exchange. The specific requirements include: (A) the establishment and operation of Exchanges; (B) the offering of qualified health plans through such Exchanges; (C) the establishment of the reinsurance and risk adjustment programs under part V; and (D) such other requirements as the Secretary determines appropriate. States must operate their exchanges under federal standards or can choose to allow the federal government to provide the exchange (either directly by the federal government or through a non-profit.). DHHS decided to do it directly through www.healthcare.gov and unfortunately experienced a number of technical problems and delays. This section also recognizes state sovereignty in health regulation and limits preemption by federal law and regulation. Finally there is a general provision for including early versions of state exchanges until they can be evaluated by the standards. I see this provision as helping establish a national platform for developing a more “level” playing field for our health insurance markets. I believe this is necessary to allow consumers not to be confused by self-serving marketing and sales strategies of insurers and to provide a consistent national marketplace for consumers and businesses to purchase health insurance. It helps set the stage for effective price competition among health plans. However, exchanges by themselves, are not likely to lead to significant improvement in the nation’s health.

Please let others know about this blog and have them “follow” @Wellness Czar on Twitter for the section topics. This information is also available in summary form by making a request to [email protected].