Health Care Exchanges – a Long Journey




Health Care Exchanges, which are a key part of federal health care reform (the Affordable Care Act or ACA), will allow consumers to choose from a variety of health plans based on the benefits offered and the prices charged.


A State can chose to build its own Exchange or default to the Federal government.


For those States that choose to build an Exchange, Colorado being one of them, they must begin enrolling consumers and employees in Qualified Health Plans (QHPs) starting October, 2013.  The State Exchange must also demonstrate to Health and Human Services (HHS), no later than January 1, 2013, that it will be ready by October of that year.


This gives an Exchange little time to meet all the requirements outlined in the 641 page set of rules published by HHS., an online network tracking health reform implementation, estimates Colorado has completed 11% of the required tasks.  This percentage is better than most States.


The Colorado legislature established an Exchange Board (SB 11-200) and the Governor and legislature have appointed its members (see the Colorado Exchange website, to read the biographies of each member).  The Board, in turn, hired an Executive Director and approved a series of advisory groups to obtain community input on Exchange development and implementation.


The Board makes its decisions in open meetings after receiving feedback from consumers and interested parties. Some of the decisions already made include:


  • Colorado should have separate Exchanges for the Employer and Individual markets;
  • The two Exchanges will run on one administrative platform in order to save money;
  • The Exchange will serve employer groups of fifty employees or less (it had the option of going up to 100); and
  • The Exchange will offer the service of collecting premiums for both small employers and individuals.


But the Board still has a number of key decisions to make and reaching consensus may not always be fast or easy.


The Board must still determine:


  • How the Exchange will verify who is eligible for individual premium subsidies and reduced benefit cost-sharing;
  • How the Exchange will electronically interface with the Medicaid program;
  • How risk adjustment and reinsurance, designed to spread risk between participating health  insurance carriers, will work;
  • How customer service will be handled and what role will the Exchange play vis-à-vis health plans;
  • What the benchmark Qualified Health Plan (QHP) will be that carriers must use as their model to fashion the benefit packages they will offer through the exchange;
  • What the role of the Navigator – a separate entity designed to help consumers who enroll in the Exchange – will be; and,
  • What plan selection options will employees have within the Exchange?


The Exchange staff, in turn, must implement the Board’s decisions, select vendors as appropriate to perform certain tasks, create the Exchange website, establish electronic interfaces with employers, carriers and State agencies and establish certain administrative functions required for the Exchange to operate in accordance with Federal law.


This is a daunting task; the Colorado Exchange continues to make excellent progress but there is still much to do and little time to do it.