OK-SAFE, Inc. Blog

March 12, 2012

HHS Issues Final Rule on Health Insurance Exchanges

Filed under: Education — oksafeinc @ 8:48 pm

OK-SAFE, Inc. – Just released is the much anticipated Final Rule  on the controversial health insurance exchanges.

Issued March 12, 2012 by the U.S. Dept. of Health and Human Services, these rules will dictate how the exchanges are to function, how they are to be governed, and what flexibility the state’s have if they decide to establish one.

As OK-SAFE has indicated all along – it doesn’t matter if the state establishes an exchange or the the federal government establishes it, the end result will be the same: the insertion of a third party into the traditional business model to create a managed “marketplace” – a marketplace that controls both the supply side and the demand side of health care. One that links patients, providers and payers into one technological network.

The model is the message.

Government will determine both the health care plans available (“certified” and “qualified”), as well as the health care providers patients can use, while giving lip service to such things as choice, competition, and clout.

Follow this link to read the entire HHS Final Rule.

Below are two announcements on the HHS Final Rule.

From U.S. Dept. of Health and Human Services website:

March 12, 2012
Contact: HHS Press Office
(202) 690-6343

Policies give states more flexibility to establish Affordable Insurance Exchanges

Health and Human Services Secretary Kathleen Sebelius today announced policies to assist states in building Affordable Insurance Exchanges.  Starting in 2014, these one-stop marketplaces will allow consumers and small businesses to choose a private health insurance plan and offer the public the same kinds of insurance choices as members of Congress.

The policies released today will help states in designing their Exchanges to best meet the needs of their consumers.  They offer states substantial flexibility as they design a marketplace that works for their residents.

“These policies give states the flexibility they need to design an Exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”

Today’s policies provide states with the guidance and certainty they need as they continue to work to build these marketplaces for their residents for operation in 2014. The policies offer guidance about the options on how to structure Exchanges in two key areas:

  • Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange;
  • Establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.”  Rest here.

From HealthCare.Gov:

Affordable Insurance Exchanges: Choices, Competition and Clout for States

The Exchange final rule includes standards for:

  • The  establishment and operation of an Exchange
  • Health insurance plans that participate in an Exchange
  • Determinations of an individual’s eligibility to enroll in Exchange health plans and in insurance affordability programs
  • Enrollment in health plans through Exchanges
  • Employer eligibility for and participation in the Small Business Health Options Program (SHOP)

This final rule is the latest in an ongoing series of steps to help states develop Exchanges. As of February 22, 2012, 49 states and the District of Columbia have received Exchange Planning grants, while 33 states and the District of Columbia have received Exchange Establishment grants. HHS is continuing to provide technical assistance to states, including technical consultations, monthly user groups, working groups on core functions, and conferences.”  Rest of announcement here.

Our recommendation is unchanged – don’t build an exchange in the state of Oklahoma.  Of course, SB 1629 will be hovering in the wings, ostensibly to wait for the Supreme Courts decision on the constitutionality of the individual mandate – but not on the exchanges, eh?

Time to stand your ground – vote NO on SB 1629 regardless of SCOTUS decision.


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