The first federal regulation regarding health insurance exchanges is expected to be released very shortly, perhaps as soon as the end of this week. The proposed regulation is formally titled “Requirements To Implement American Health Benefit Exchanges and Other Provisions of the Affordable Care Act.” For the past two weeks, it has been at the Office of Management and Budget (OMB) for review, the final step in the federal regulatory process before public release.
The rule is expected to address what federally approved exchanges will look like, how much states need to do to have their exchanges certified in 2013 and how they can adopt models being developed elsewhere in the country. It is not expected to cover certain key issues like essential benefits, which are still being defined by the Institute of Medicine (IOM), and is likely to be one in a series of proposed rules on health insurance exchange structure released over the next year.
Many states have been eagerly anticipating the release of this regulation to help guide either their legislative or executive-level actions on state-level exchange development. Currently 10 states have enacted some type of exchange legislation and three more states have exchange bills sitting on their governor’s desks. Six more states are still in session and technically have live exchange bills, though in some states these bills are either not moving or are unlikely to move. Fifteen states had exchange legislation introduced and defeated this spring, and six states are actively looking into other means of creating an exchange, such as an executive order from the governor or using the authority of the state’s existing high-risk health insurance pool to move forward. Just this past week, exchange legislation was killed in Rhode Island, and Governor Lincoln Chafee is considering adding his state to that list of six and moving ahead using an executive order, as he is “committed to establishing an exchange that allows Rhode Islanders to access affordable, quality health care.”