Health Insurance Exchanges and the Affordable Care Act: Eight Difficult Issues Timothy Stoltzfus Jost, J.D. Robert L. Willett Family Professor of Law, Washington and Lee University School of Law Alliance for Health Reform, Briefing on Health Insurance Exchanges October 22, 2010

Eight Difficult Issues for HHS and States How should the exchanges be governed? State entity or non-profit? How should adverse selection against exchange and among plans sold in exchange be further deterred – what are options for states and HHS? Opening the exchanges to large employers or not? What are the key considerations for states and how should federal government reduce risk to the exchanges from self-insured and large employers? How can the exchanges be made to work well for employers to encourage their participation?

Eight Difficult Issues for HHS and States Exchanges must certify qualified plans – how should they exercise their regulatory role in this regard? Allow all plans to participate or restrict participation to high value plans? Standardize plans beyond ACA? Exchanges must provide information to consumers to facilitate informed choice about health plans – how should the exchanges meet this responsibility? How should exchanges ensure expedient and continuous enrollment of those eligible for Medicaid/CHIP and premium/cost-sharing credits? How might exchanges reduce their own administrative costs and those of their users, and how will they finance their activities?