In the United States, the health insurance market , also called healthcare exchange , is an organization in every country where people can purchase health insurance. People can purchase health insurance that complies with the Patient Protection and Affordable Care Act (ACA, known as "Obamacare") on the ACA health market, where they can choose from various health care plans regulated by the government and the standards offered by insurance company. participate in the exchange.
ACA Health Exchange is fully certified and operates on 1 January 2014, under federal law. Registration in the market begins on October 1, 2013, and continues for six months. On April 19, 2014, 8.02 million people have registered through the health insurance market. An additional 4.8 million joined Medicaid. Registration for 2015 starts on November 15, 2014 and ends on December 15, 2014.
Private non-ACA health care exchanges also exist in many states, which are responsible for registering 3 million people. This exchange precedes the Affordable Care Act and facilitates insurance plans for small and mid-size business employees.
Video Health insurance marketplace
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Health insurance exchanges in the United States extend insurance coverage while allowing insurance companies to compete in a cost-effective manner and help them comply with consumer protection laws. The exchange is not an insurance company, so they do not run the risk themselves, but they decide which insurance companies participate in the exchange. Ideal exchanges promote insurance transparency and accountability, facilitate increased subscription registration and delivery, and help spread the risk of ensuring that costs associated with expensive medical care are shared more broadly across large groups of people, rather than spread across only a few beneficiaries. The exchange of health insurance uses electronic data exchange (EDI) to transmit necessary information between exchanges and operators (trading partners), especially 83 transactions for registration information and 820 transactions for premium payments.
Maps Health insurance marketplace
History
Health exchanges first appeared in the private sector in the early 1980s, and they used computer networks to integrate claims management, verification of eligibility, and inter-operator payments. It became popular in some areas as a way for small and medium businesses to accumulate their purchasing power into larger groups, reducing costs. An additional advantage is the ability of small businesses to offer a variety of plans to employees, allowing them to compete with larger companies. The largest such exchange before the ACA was CaliforniaChoice, founded in 1996. In 2000, CaliforniaChoice membership included 140,000 individuals from 9000 business groups.
Obamacare maintains the concept of health insurance exchange as a key component of health care. President Obama declared that it should be "a marketplace where Americans can do a one-stop shop for health care plans, compare benefits and prices, and choose the best plan for them, in the same way that Congressmen and their families can None of these plans should reject coverage under pre-existing conditions, and all these plans should include an affordable basic benefit package that includes prevention and protection of disaster costs.I strongly believe that Americans should have public health options. insurance options that operate together with personal plans.This will give them better options, make the healthcare market more competitive, and keep insurance companies honest. "Although the House has sought a single national exchange as well as public options, the Patient Protection and Care Act Affordable (ACA) that passes by will be a state-based exchange, and public options are ultimately derived from the bill after it has not won the proof-support proof in the Senate. Countries may choose to join together to run multi-state exchanges, or they may opt out of running their own exchange, in which case the federal government will go in to create an exchange for use by their citizens.
The ACA was signed into law on March 23, 2010. The law requires that health insurance exchanges begin operating in each country on October 1, 2013. In the first year of operation, open registration on the stock runs from 1 October 2013, to March 31, 2014, and an insurance plan purchased on December 15, 2013, beginning coverage on January 1, 2014. For open enrollment 2015 begins on November 15, 2014 and ends on February 15, 2015.
The execution of individual exchanges changes the practice of insuring individuals. This market expansion is the main focus of the ACA. More than 1.3 million people have chosen plans for 2015 market coverage in the first three weeks of this year's open enrollment period, including people who update their coverage and new customers.
Subsidies for insurance premiums are given to individuals who buy plans from exchange and have a household income of between 133% and 400% of the poverty line. Section 1401 (36B) PPACA explains that any subsidy will be granted as a refundable and refundable tax credit and provide a formula for calculation:
Except as provided in paragraph (ii), the applicable percentage with respect to the taxpayer for each tax year shall be 2.8 percent, increasing by the number of percentage points (not more than 7) having a ratio equal to 7 percentage points as home income the taxpayer ladder for the tax year of more than 100 percent of the poverty line for the family of the size involved, is charged at an amount equal to 200 percent of the poverty line for the family of the size involved. * (ii) SPECIAL RULES FOR TAXPAYERS IN 133 TOTAL POVERTY LINES - If the taxpayer's household income for the tax year is more than 100 percent but not more than 133 percent, the poverty line for the family of the size involved, the percentage applicable tax is 2 percent.
The refundable tax credit is a way to provide government benefits to individuals who may not have tax obligations (such as income tax credits earned). The formula was amended in the amendment (HR 4872) by March 23, 2010, in section 1001. To qualify for the subsidy, the recipient can not qualify for other acceptable coverage. The US Department of Health and Human Services (HHS) and Internal Revenue Service (IRS) on May 23, 2012, issued a joint final regulation on the implementation of a new health insurance exchange to cover how the exchange will determine eligibility for uninsured individuals. and employees of small businesses who want to buy insurance on the exchange, as well as how the exchange will handle the determination of eligibility for low-income individuals applying for newly expanded Medicaid benefits. Premium hats have been delayed for a year on group plans, to give employers time to set up new accounting systems, but hats are still planned to apply as scheduled for insurance plans on the exchange; The HHS and Congressional Research Service calculated what the income-based premium cap for the "silver" health plan for a family of four would be in 2014:
Issues assured
In the individual market, sometimes considered as "residual market" insurance, insurance companies generally use a process called underwriting to ensure that individuals pay for their actuarial value or to refuse coverage at all. The House Committee on Energy and Trade found that, between 2007 and 2009, the four largest insurance companies rejected insurance for 651,000 people for previous medical conditions, a figure that increases significantly each year, with a 49% increase over that time period.. The same Memorandum says that 212,800 claims have been denied payment due to pre-existing conditions and that the insurer has a business plan to restrict the money paid based on pre-existing conditions. Persons who may not receive insurance under previous industry practice are guaranteed insurance under ACA. Therefore, insurance exchanges will shift large amounts of financial risk to insurance companies, but will help divide the cost of risk among a large pool of insured individuals. The prohibition of the ACA to deny coverage for existing conditions began on January 1, 2014. Earlier, several state and federal programs, including the most recent ACA, provided funding for the state-run high-risk pools for those with existing conditions. Some countries have continued their high-risk pool even after the first market registration period.
Limit to price variations
- Costing Factors Allowed in exchange under ACA:
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- Age: 3: 1
- Smoking status: 1.5: 1
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Price variations will be allowed by area (in a state) and family composition ("tier") as well.
Comparable plan level
In exchange, insurance plans are offered in four designated levels from the lowest to the highest premium premiums: bronze, silver, gold, and platinum. The range of plans ranges from 60% to 90% of the bill in multiples of 10% for each plan. For those under 30 (and those with a difficult exception), a fifth "disaster" rate is also available, with very high deductibles.
Insurance companies choose doctors and hospitals that are "in the network".
Supporters of health care reforms believe that enabling comparable plans to compete for consumer businesses in a convenient location will drive prices down. Having a centralized location improves consumer knowledge about the market and enables greater conformation for perfect competition. Each of these plans will also limit the liability for consumers with out-of-pocket expenses of $ 6,350 for individuals and $ 12,700 for families.
2015
A study by Avalere Health says that health insurance premiums from popular plans available under Obamacare for 2015 rose 3-4%.
According to the US Department of Health & amp; Human Services, as registration for the Health Insurance Market starting on November 15, approximately 11.4 million people have explored their options, learned about available financial aid, and registered or updated health plans that meet their needs and fit their budget. As of February 2015, $ 268 is the average monthly tax credit for people eligible for financial assistance in 37 states using HealthcCare.gov until 30 January.
Economic health insurance exchange: an individual's mandate
The health insurance advocacy group of America's Health Insurance Plans is willing to accept these limitations on pricing, limitation and registration due to individual mandates: The mandate of an individual requires that all individuals purchase health insurance. This ACA requirement allows insurance companies to spread financial risk from newly insured people to existing conditions among a larger set of individuals.
In addition, a study conducted by Pauly and Herring estimated that individuals with pre-existing conditions in the 99th percentile of financial risk represented 3.95 times the average (average) risk. The figures from the House Committee on Energy and Commerce will show that about 1 million high-risk individuals will pursue insurance on health-care exchanges. Congress estimates that 22 million people will be newly insured on the health benefits exchange. Thus high-risk individuals do not count high enough to increase the net risk per person from previous practice. Therefore, it is theoretically advantageous to accept an individual's mandate in exchange for the conditions presented in the ACA.
Acronym
HIX (eXchange Health Insurance) appears as a de facto acknowledgment among state and federal government stakeholders, and private sector technology and service providers that help countries build their exchange. The HIX acronym distinguishes this topic from the exchange of health information, or HIE.
The de facto acronym of the HIX will be replaced by HIEx in the 3rd edition of the HIMSS Dictionary of Healthcare Information Technology, Acronyms and Organizations, which will be released in March 2013.
Criticism and controversy
First week of operation
The message, "Please try again later", was greeted by many people who tried to see information about market websites throughout the United States during the first week of operation. The website is reported to be interrupted or offers a very slow response time. A statement by Todd Park, US Chief Technology Officer, resolved the initial dispute over whether the perpetrator was a higher volume of views or deeper technical problems: he insisted that the disruption was caused by unexpected high volumes in federal healthcare (HealthCare.gov), when the site attracted 250 thousand visitors instead of the 50-60 thousand expected, and claimed that the site would work with fewer visitors. More than 8.1 million people visit this site from October 1-4, 2013.
On the date of Patient Protection and the Affordable Care Act of 2010 came into force, only a handful of health insurance exchanges around the country began operations. Among them are Massachusetts Health Connectors, New York HealthPass - non-profit exchange, and Utah Health Exchange. Advocates claim these exchanges make this "market" more efficient, provide oversight and structure, arguing that the previous health insurance market in the United States is not well-organized and handles variations in scope and requirements among different companies, employers, and policies.
It is not known how many people made it into the first week. The federal market website is scheduled for maintenance on weekends. Some journalists have dubbed the "Slowbamacare" program.
The CGI Group came under media scrutiny as the developer behind several market websites, after many problems arose with the federal health insurance market, HealthCare.gov.
On October 1, 2013, state-run markets are also open to the public, and some report the first statistics. During the first week of registration:
- 28,699 people registered in the California health plan market
- 17,300 people enrolled in the Kentucky health plan marketplace
- Over 40,000 people are enrolled in the NY State of Health market
- On October 8, 2013, The Seattle Times reported that over 9,400 people have been registered on the Washington health plan market. However, a report later clarified that many of those included were Medicaid registrants. On October 21, 2013, only 4,500 Washington residents are registered in private insurance through the state market.
Tax suspension delay
On October 23, 2013, The Washington Post reported that Americans without health insurance would have an additional six weeks before they would be punished. The deadline was extended until March 31, and those who did not register at that time may still avoid punishment arising and locked out of the healthcare registration system this year. Exceptions and extensions apply to:
- Those living in countries that use federal exchange, who can avail themselves of a "special period" that allows individuals to avoid punishment and enroll in a health plan by checking the blue box in mid-April 2014, states they try to register before the deadline (thereby providing an undetermined amount of time to actually register afterwards). The New York Post reports: "This method will depend on the honor system, the government will not try to determine whether the person is telling the truth". State-run stock exchanges have their own rules; some will provide similar extensions.
- Member of Pre-Existing Condition Insurance Program, which is granted a one-month extension until the end of April 2014.
- Those who have successfully applied exclusion status based on the criteria published by HealthCare.gov, who are not required to pay a tax penalty if they do not enroll in a health insurance package.
Primary concern
- Exclusion of many low-income individuals
- NPR reports that large numbers of low-income people are excluded in states that do not offer Medicaid expansion to 133% of poverty line.
- High premium for young single adult
- There is some speculation that for single people aged between 18-35 the cost of insurance will increase.
- Data security
- The Minnesota health exchanges reportedly accidentally sent personal information via email to over 2,400 insurance agents to insurance brokers, according to the Minnesota Star Tribune.
- Loss of group coverage for part-time employees
- According to NPR, some companies such as Trader Joe's and Home Depot have decided to end health insurance for their part-time workers.
- Fraud
- Fraud is expected due to confusion over registration.
- Network is limited and narrow
- Some exchanges have been criticized for offering health plans that require too many claims outside the network. On October 5, 2013, Seattle Children's hospital filed a lawsuit due to "failure to ensure adequate network coverage" when only two insurance companies included Children in their market plan.
- Concern has also been raised about the efforts of insurance operators to limit the number of providers on their networks to reduce costs. A study of the California market confirmed these concerns, but also showed that geographic access was similar and qualified when excelling in a market-based plan.
- "Cherry-picking"
- The private health insurance industry is worried that limited restrictions and too small a market size can lead to higher premiums, encourage cherry-picking customers by insurance companies, and force the opening of bourses. That's what some believe will happen in Texas and California in their failed exchanges. One of these factors, cherry-picking customers, will not be possible in ACA-mandated state exchanges, as all insurance plans will be "secured" by 2014. Furthermore, legislation will bring in millions of new entry into the market by means of the mandate requirements of individuals for all citizens to purchase health insurance and increase market size.
Congressional Reactions
On 28 and 29 October 2013, Senator Lamar Alexander (R-TN) and Rep. Lee Terry (R, NE-2) introduced the Information Disclosure Act (S. 1590 and H.R.3362, respectively). Terry's bill will require the US Department of Health and Human Services to submit a weekly report to Congress on HealthCare.gov status including "... weekly updates on the number of unique website visitors, new accounts, and new enrollment in a quality health plan, as well as level of coverage, "separating data by country, as well as reports on attempts to repair broken parts of the website. Reports will mature every Monday to March 31, 2015, and will be publicly available.
On January 16, 2014, the Terry Bill was ratified by the House of Representatives; 226 Republicans and 33 Democrats voted yes. Bill Alexander died on the committee.
Close Oregon site failure
In March 2015, Oregon formally abolished its health insurance market.
Private health insurance exchanges
Private health insurance exchanges are exchanges run by private or nonprofit companies. The health plan and the insurance operator in a personal exchange must meet certain criteria determined by the exchange management. Private exchanges incorporate human technology and advocacy, and include online verification of eligibility and mechanisms to permit employers to connect their employees or retirees with an exchange to offer subsidies. They are designed to help consumers find personalized plans for their specific health conditions, preferred doctors/hospital networks, and budgets. These exchanges are sometimes called markets or intermediaries, and work directly with insurance carriers, who effectively act as extensions from operators. The largest and most successful private healthcare exchange is CaliforniaChoice, founded by Word & amp; Brown General Agency in 1996.
Personal health exchanges precede the Affordable Care Act. One example of an initial health care exchange is the International Medical Exchange (IMX), a company financed in Louisville, Kentucky, by Telephone and Cabling Standards, a major British technology company (now Nortel), to develop the concept of exchange in the US using on- line. This product was made in the mid-1980s. IMX develops a feasibility verification system, claims management system, and a bank-based payment administration system that will manage payments between patients, employers, and insurance carriers. As proposed today's exchanges, focus on standard care, review of third party utilization, private insurance company participation, and cost reduction for health care systems through product simplification. The focus is on creating local or regional exchanges that offer a set of standard health care plans that reduce the complexity and cost to acquire or understand health care insurance, while simplifying claim administration. The system is modeled after the standard exchange and back office processes of the banking industry. The main difference is that IMX healthcare exchange will provide their products through the national network of existing commercial banks rather than making duplicate payments and network administration systems as proposed today. IMX product rights are acquired by Anthem (later Blue Cross and Blue Shield of Kentucky). The exchange products form the basis for the settlement of inter-operator claims between commercial insurance operators and Blue Cross organizations. The founders of IMX are from top management at Humana, and top management of First Tennessee National Corp (now First Horizon).
In overlapping markets, the coexistence of public and private exchange plans can cause confusion when talking about "exchange plans". In California, Anthem Blue Cross offers HMO plans through both state-run Covered California exchanges and CaliforniaChoice personal exchanges, but doctors' networks are not identical. Physicians who advertise the reception of the HMO Blue Cross Exchange Anthem can provide false information to the people enrolled in Anthem Blue Cross Exchange HMO via private exchange.
See also
- Health care reform in the United States
- The health system
- Universal health coverage by country
References
External links
- HealthCare.gov
- Federal Funding Status for the Implementation of the State Health Insurance Exchange Congressional Research Service
- C-SPAN Video Library: Search for Health Insurance Exchange
- View the "Clips" tab and then "Timeline Clipping" to abstract the edited clip from the following video:
- Health Protection Act 22 Apr 2013, Jenny Gold, correspondent of Kaiser Health News, Interview
- Report Video Health Insurance Exchange Issues Jul 25, 2013, Polico Pro Health Breakfast Supervision
- Update on Health Care Act Jul 1, 2013, Julie Rovner, health policy correspondent National Public Radio, Interview
- HealthInsurance.org's guide to US country healthcare
- Overview of Health Insurance Exchange, Congressional Research Service, July 1, 2016
- Group Health Insurance Since 1977
Source of the article : Wikipedia
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