These publications are available from the Wisconsin Legislature’s Theobald Legislative Library





Health Insurance Exchanges

Compiled by Nesara Kishor, October 2010
www.legis.wisconsin.gov/lrb/pubs/tapthepower.htm

The recent federal health care legislation has made sweeping changes to health care and health insurance. One of the many changes in the
coming years will include the mandatory implementation of health insurance exchanges across all states beginning January 1, 2014. This
will raise questions and concerns as states begin working on legislation to implement these exchanges. This bibliography will provide
resources that may contribute to our understanding of health insurance exchanges.
General Overview
“Explaining Health Care Reform: Questions About Health
Insurance Exchanges” / Kaiser Family Foundation, April 2010.
“This summary provides responses to questions about the purpose
and function of exchanges and how they relate to the regulation of
the insurance market.”
www.kff.org/healthreform/upload/7908-02.pdf
“Explaining Health Reform: Eligibility and Enrollment Pro-
cesses for Medicaid, CHIP, and Subsidies in the Exchanges” /
Kaiser Family Foundation, August 2010. Provides explanations
of different provisions in the law. The enrollment system for Medic-
aid, CHIP, and subsidies in the exchange must be consumer-friendly,
coordinated, simplified, and technology enabled. Summarizes the
various positions in the law that address these goals.
www.kff.org/healthreform/upload/8090.pdf
Health Reform: What Legislators Need to Know About
Exchanges / National Conference of State Legislatures. June
4, 2010. Webinar. Slides provide legislators with information
about the various functions of an exchange, such as the certifica-
tion of health plans and determining eligibility standards for subsi-
dies, Medicaid, and CHIP. Discusses relevant issues regarding
governance, implementation, and opportunities for states.
www.ncsl.org/portals/1/documents/health/
Exchangeswebinar60210.pdf
“Moving Forward on Health Reform” / Health Affairs, June
2010. (614.23/P94/2010/v.29/no.6)
This issue focuses on various topics in health reform, including
health insurance exchanges. A sampling of some articles in this
issue:
S “Insurance Exchanges Under Health Reform: Six Design
Issues for the States”
S “How Will Health Insurers Respond to New Rules Under
Health Reform?”
S “From Massachusetts to 1600 Pennsylvania Avenue: Aboard
the Health Reform Express”
Patient Protection and Affordable Care Act of 2009: Health
Insurance Exchanges / National Association of Insurance
Commissioners. April 20, 2010. Lists the provisions in the
Patient Protection and Affordable Care Act relevant to the health
exchanges in the form of a chart, highlighting key features, appli-
cability, and effective dates.
www.naic.org/documents/committees_b_Exchanges.pdf
Private Health Insurance Provisions in PPACA (P.L. 111-148) /
U.S. Congressional Research Service. April 15, 2010.
Provides an in-depth analysis and explanation of the health insur-
ance exchanges described in the Patient Protection and Affordable
Care Act. Explains the essential health benefits package, qualified
health plans, eligibility for individuals and small businesses, as
well as premium and cost-sharing subsidies as they relate to the
exchange.
http://assets.opencrs.com/rpts/11-148_20100415.pdf
State Implementation of Federal Health Reform / National Con-
ference of State Legislatures. Updated September 20, 2010.
Provides a comprehensive table detailing state actions in imple-
menting reform, including introduced bills and laws.
www.ncsl.org/default.aspx?tabid=20231
“Summary of Coverage Provisions in the Patient Protection
and Affordable Care Act” / Kaiser Family Foundation, April
28, 2010. (368.6/K12f) Brief overview of American Health Bene-
fit Exchanges. Specifies eligibility and options for structure.
Benefits offered must meet specified standards. Premium and
cost-sharing subsidies are available to qualified individuals.
www.kff.org/healthreform/upload/8023-R.pdf
Issues to Consider
Critical Employer Issues in the Patient Protection and Afford-
able Care Act / U.S. Chamber of Commerce. April 26, 2010.
Geared toward employers, this report serves “as a handbook for the
business community.” Brief explanation of the Small Business
Health Options Program (SHOP) exchanges.
http://library.uschamber.com/sites/default/files/
100426_critical_employer_issues_ppaca.pdf

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 Health Insurance Exchanges
Continued
The Exchange Equation: Avoiding a Death Spiral with a Bal-
ance of Risks / The Commonwealth Fund. December 18, 2009.
State-based exchanges in the past have suffered from adverse
selection and high premiums. Discusses measures that could pre-
vent such problems, such as a large market pool and incentives to
choose “efficient, high quality plans.”
www.commonwealthfund.org/Content/Newsletters/Washington-
Health-Policy-in-Review/2009/Dec/December-21-2009/
The-Exchange-Equation-Avoiding-a-Death-Spiral-
with-a-Balance-of-Risks.aspx
Health Insurance Exchanges in Health Care Reform: Legal and
Policy Issues / The Commonwealth Fund. December 31, 2009.
Several questions and policy issues must be taken into consider-
ation when designing the exchanges. Exchanges must be designed
to discourage adverse selection, encourage balanced risk pools,
and reduce administrative costs.
www.commonwealthfund.org/Content/Publications/
Fund-Reports/2009/Dec/Health-Insurance-Exchanges-in-Health-
Care-Reform-Legal-and-Policy-Issues.aspx
A State Policymakers’ Guide to Federal Health Reform: Part I,
Anticipating How Federal Health Reform Will Affect State Roles /
National Academy for State Health Policy. November 2009.
(368.6/N214b) Identifies broad areas of focus in current state
reform efforts, asking “will [federal] reform support or impede
progress toward existing state health system improvement goals?”
Experience in Other States
“Health Insurance Exchanges: Organizing Health Insurance
Marketplaces to Promote Health Reform Goals” / Urban Insti-
tute, April 2009. Examines the operation of the Massachusetts
Connector and the ways in which exchanges could address current
issues facing consumers of insurance. www.urban.org/
UploadedPDF/411875_health_insurance_marketplaces.pdf
Health Insurance Exchanges: See How They Run / Alliance for
Health Reform. May 11, 2009. Webcast. A series of panelists
present a discussion about the exchanges and reform goals they
could accomplish, focusing on experience with the Massachusetts
Connector as a model. www.kaisernetwork.org/health_cast/
hcast_index.cfm?display=detail&hc=3134
“Overview of Massachusetts Health Reform: Exchange
Design Issues & Lessons Learned” / National Conference of
State Legislatures. July 25, 2010. Slides. Slides give a brief
overview of the Commonwealth Choice and Commonwealth Care
program, including its subsidized and non-subsidized options.
Provides statistics on the successes and shortcomings of the
exchange. Lessons learned stress the importance of campaigning,
communication and collaboration, consolidating legacy problems,
and more. www.ncsl.org/portals/1/documents/health/
Exchanges_KingsdaleLS10.pdf
“The Utah Health Exchange: Ten Lessons Learned from the
Utah Experience” / National Conference of State Legislatures,
July 26, 2010. Slides. Provides guidelines for implementing
exchanges based on experience with the Utah Health Exchange.
Documents the timeline of events involved in the Utah exchange,
demonstrates the functions on its Web site, and compares the Utah
model with the Massachusetts Connector. www.ncsl.org/
portals/1/documents/health/Exchanges_ClarkLS10.pdf
Criticisms
“Health-Care Reform: Is the Landmark New Plan a Good
Idea?” / Congressional Quarterly, Inc., CQ Researcher, June 11,
2010, v.20, no.22. (368.6/C763c) Examines questions and issues
regarding the health reform law, describing insurance exchanges
as a “pro competitive” element in the law “to encourage private
insurers to emphasize cost and quality control.” Criticizes that
coverage through an exchange would be “inadequate” for consum-
ers.
“Prescription for a Health Insurance Compromise: Forget the
Public Option and Co-Ops, Rewire the Exchange” / Commit-
tee for Economic Development. September 24, 2009.
Criticizes that exchanges would “fail to pressure private insurers
to hold down premiums.” Advocates for Congress to rewrite the
law so that exchanges could “attract a pool of participants that are
average in risk, large in size, and driven by proper incentives.”
Points to the Dane County (Wisconsin) Exchange model as one
that has been able to control premiums.
www.ced.org/commentary/65-commentary/378-prescription-for-
a-health-insurance-compromise-forget-the-public-option-and-
co-ops-rewire-the-exchange
Related Web Sites
GPO Access: www.gpoaccess.gov/fr “The Federal Register is
the official daily publication for rules, proposed rules, and notices
of Federal agencies and organizations.”
Healthcare.gov: www.healthcare.gov The official government
Web site that provides information to consumers on the Patient
Protection and Affordable Care Act.
Massachusetts Health Connector: www.mahealthconnec-
tor.org/portal/site/connector Official Web site for the Massa-
chusetts Health Exchange.
National Association of Insurance Commissioners:
www.naic.org Provides information on the health reform with an
added focus on the role of the NAIC in creating many of the stan-
dards and methodologies required in the law.
National Conference of State Legislatures: www.ncsl.org
Provides updated information on state actions. Go to Health
Reform Implementation, or search for “insurance exchanges.”