Mark Merlis, Consultant
Many reform proposals call for the creation of one or more health insurance exchanges, intermediaries that can help individuals or small employers navigate the insurance market. An exchange might be public or private, national, or local. It might serve simply as a clearinghouse for plan information or could play an active role in setting benefit packages, choosing high-quality plans, and negotiating premium rates. This paper begins with a summary of recent experience with insurance exchanges and similar systems. It then reviews basic issues in the design of an exchange.
A recent Forum series on health insurance reform included sessions on underwriting, rating, and regulation in the individual market (December 3, 2008); rating rules in the individual market, part II (February 19, 2009); health insurance exchanges (March 6, 2009); health insurance exchanges, part II (April 15, 2009); risk adjustment and rating in the small-group market (March 20, 2009); actuarial equivalence (April 7, 2009); and federal/state regulatory roles, subsidy administration (May 8, 2009).
For more information on health insurance exchanges, see "Health Insurance Connectors and Exchanges: A Primer for State Officials," by Amy Lischko (Academy Health State Coverage Initiatives, September 2007).