Using State Health Insurance Exchanges

to Drive Better, More Cost Effective Care


Under the Affordable Care Act, states are actively developing health insurance marketplaces (AKA exchanges) to make health coverage easier and more affordable. Starting in 2014, marketplaces will allow individuals and small businesses to compare health plans, get answers to questions, find out if they are eligible for tax credits for private insurance or health programs like the Children’s Health Insurance Program (CHIP), and enroll in a health plan that meets their needs. States can also use their exchanges to build patient centered medical homes that can improve health and save money. More than ever, state governments need flexible, replicable, and sustainable solutions that integrate a full spectrum of services while operating under a tight budget. Working in collaboration with health providers, consumers, employers, health plans, and others to design the best model for their own state, policymakers can integrate key features of the medical home model into their exchanges in either a comprehensive or step-by-step building block approach. Exchanges can be designed to reflect the unique needs of the States, striking a balance between current system infrastructure and new features. The flexibility of design offered by the Exchanges allows customization to provide systems that fall along a continuum from open market, passive purchaser designs to active purchaser arrangements. This guide offers recommendations for states to maximize exchanges as a vehicle to drive health reform and encourage widespread adoption of the medical home model.

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