Health Insurance Exchanges Toolkit
A collection of resources to assist employers and their advisors in understanding the impact of the health insurance exchanges under the Affordable Care Act (ACA).
In addition to many reforms that directly impact group health plans, the Affordable Care Act ( www.practicallaw.com/6-505-8403) (ACA) required each state to establish, by January 1, 2014, a health insurance exchange (also known as a "marketplace") to:
Assist individuals in the purchase of qualified health plans (QHPs) (that is, private health insurance that meets certain standards).
Establish a Small Business Health Options Program (SHOP) Exchange to assist small employers in enrolling their employees in QHPs offered in a state's small group market.
For states that chose not to implement their own exchange, the federal government was required to establish and operate an exchange in the state. Within a federally facilitated exchange, however, a state could develop a "state partnership exchange," under which the state administers and operates exchange activities associated with plan management and consumer assistance.
The ACA health insurance exchanges have been addressed in numerous sets of agency regulations and related guidance, on issues including:
Establishment and functions of the exchanges.
Certification of QHPs offered under an exchange, and the scope of benefits available under QHPs.
Eligibility standards for exchange participation.
Consumer assistance tools and programs for accessing the exchanges.
Open enrollment for exchange-based coverage began in October 2013, though the launch of the federal government's exchange website was hindered by software crashes and resulting delays.
In June 2015, the US Supreme Court ruled that premium tax credits offered to subsidize coverage under the ACA health insurance exchanges (that is, under Section 36B of the Internal Revenue Code ( www.practicallaw.com/2-382-3555) (26 U.S.C. § 36B)) are available in both states with a state-run exchange and those with a federal exchange (King v. Burwell, 135 S.Ct. 2480 (2015)) (see Legal Update, Supreme Court Upholds ACA Subsidies ( www.practicallaw.com/4-616-7746) ).
Against this uncertain backdrop, this Toolkit provides resources to assist employers and their advisors in understanding various aspects of the exchanges, including both the public marketplace legislated under the ACA and the emerging private market of insurance exchanges.