Blueprint: Advancing Health Security By Ensuring Strong Exchanges

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Final Blueprint Conference Call: Job Creation: Feb. 22nd


Please join the Progressive States Network on Tuesday, February 22nd, for a conference call on creating jobs and boosting local economies.  The call will focus on messaging and framing around several key policies, including green jobs workforce development, energy efficient schools and buildings, and innovative financing mechanisms for energy efficiency and clean energy projects. We'll be joined on the call by:

  • Maine State Representative Diane Russell
  • Emmaia Gelman, New York’s Center for Working Families
  • James Irwin, Center on Wisconsin Strategy
  • Rob Brown, Opportunity Maine

You can RSVP for this call by clicking here.



Blueprint: Advancing Health Security by Ensuring Strong Exchanges

Health Care for All 


The Patient Protection and Affordable Care Act has been the topic of heated political debate since becoming the law of the land almost one year ago. As right-wing calls for repeal continue to make headlines, many positive and popular provisions of the law are already benefiting families across the nation. Working-class and middle-class families have seen their health security increased by provisions that rein in insurance industry abuses and expand coverage, making it less likely that they will lose their savings due to an illness or injury, or be unable to afford needed treatments.

But as the curtain draws on the first year of the life of the Affordable Care Act, what happens in the second year at the state level may prove to be even more critical to its ultimate fate.

In 2011, the shape of the most prominent piece of the law -- and the health security and economic security of American families for decades to come -- will be decided in statehouses across the nation. This legislative session, states have a once-in-a-generation opportunity to put consumer protections and stronger access to affordable health care coverage in the hands of their residents.

Under the health law enacted in March 2010, states are tasked with setting up health care "exchanges," or marketplaces that will create new incentives for the health insurance industry to deliver quality care at lower prices. Exchanges will require insurance companies to spend more of consumers’ premium dollars on actually providing health care -- instead of bloated administrative overhead and egregious compensation for CEOs.

As part of our 2011 Blueprint for Economic Security, Progressive States Network has compiled an overview of how to Enact a Progressive State Exchange this session, including a focus on key legislative elements of a strong exchange such as determining the Governance of the health exchange and creating a Board Structure that will ensure a strong governing body, as well as a set of Next Steps for creating a strong exchange.

Under the timeline set out in the Affordable Care Act, state exchanges are scheduled to begin operating in 2014 -- but every state legislature must act this session to pass a strong version of an exchange in their state if they do not want the federal government to run their exchange. By implementing a strong exchange, states can allow the uninsured, self-employed and small businesses to shop for insurance in a competitive marketplace, giving consumers greater control and power through information and choice.

While conservatives remain focused at the federal level on judicial and legislative attempts to overturn or repeal the law, at the state level they have largely been focused on implementing the same law they want to see overthrown. But as the right attempts to shape weak exchanges that protect the insurance industry while gutting the consumer protection and affordability provisions of the law, progressives can counter with proposals to build strong exchanges that protect the health security of everyday families.

At a moment when unemployment remains high and good jobs (including jobs that provide health coverage) are still not being created fast enough, health security remains a primary concern for families everywhere. In making the economic and pragmatic argument to build strong state health exchanges this year, progressives can also help ensure that the policy debate around health care starts to reflect the dinner-table debate that families are having across the nation.

Read more on Health Security as part of Progressive States Network's Blueprint for Economic Security 2011, or click any of the links below for more on the following critical elements of state exchange implementation:

Enacting Progressive State Exchanges: Overview


Perhaps the most prominent policy to come out of the Affordable Care Act (ACA) is one that will not take effect until 2014: new state-based insurance marketplaces, also known as “exchanges.” These marketplaces will be one-stop shops where individuals and small businesses can find information on insurance options for health care coverage that provide for portability. Overall, it is Progressive States Network’s strong recommendation that individual states take advantage of the flexibility provided for in the law, and design an exchange that fits the state best and keeps the consumer’s interest in mind.

A strong exchange is the most critical element that progressive policymakers and legislators can focus on right now in order to build the health security of all families and the economic security of our states. The recommendations that follow outline a basic set of standards for the structure of an exchange. Each state can build on this foundation -- the models outlined below should be seen as a floor, not a ceiling.


Ensuring Strong State Exchanges: Governance


Governance will create the building block for the structure of the exchange. The first step for lawmakers is to determine if state laws need to be changed in order to develop and implement a state based exchange. These might include procurement and personnel laws as well as rulemaking authority for the exchange structure. The governance and oversight functions of the exchange must be clearly defined in order to allow for a strong, progressive exchange.

Progressive States Network has reviewed guidance on the governance of the exchange based on the National Academy of Social Insurance (NASI) model legislation, and recommends the following menu of options for legislators, with consideration for each state’s differing political environment: Creating an independent exchange under the executive branch, utilizing an existing state agency, or establishing a non-profit exchange.


Ensuring Strong State Exchanges: Board Structure


Perhaps the most significant guidance that Progressive States Network recommends related to governance is that lawmakers write prescriptive language defining the governance of the exchange and the board structure. Doing so will ensure that the oversight and operation of the exchange is the most efficient for consumer navigation and provides strong consumer protections. Board members of the exchange must be politically balanced, represent consumers and the community-at-large (including meeting diversity guidelines), and not present any conflict of interest, such as membership by an insurance company or regulator. It is further recommended that the board structure be subject to state open meetings laws, open records laws, and public hearings laws. This will give the public an opportunity to weigh in and provide input, providing a greater consumer perspective to hold the exchanges accountable.


Ensuring Strong State Exchanges: Next Steps


Over the next few weeks, crucial decisions regarding implementation of the Affordable Care Act will be made during state legislative sessions. With that in mind, Progressive States Network is prepared to provide guidance on the key issues relevant to lawmakers in 2011 and the upcoming months. We are in the process of identifying the next steps to aid in the implementation process. Issues of immediate importance include: Benchmarks, Transitioning and interface between systems including Medicaid and other public programs and exchanges, Cost Control and Funding, and Essential Benefits.


The Stateside Dispatch is written and edited by:

Nora Ranney, Legislative Director
Marisol Thomer, Outreach Director
Devin Boerm, Health Policy Specialist
Fabiola Carrión, Broadband and Green Jobs Policy Specialist
Cristina Francisco-McGuire, Election Reform Policy Specialist
Tim Judson, Workers' Rights Policy Specialist
Suman Raghunathan, Immigration Policy Specialist
Altaf Rahamatulla, Tax and Budget Policy Specialist
Mike Maiorini, Online Technology Manager
Charles Monaco, Press and New Media Specialist
Ben Secord, Outreach Specialist

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