Policy Brief | Oct. 2012

Optimizing Consumer Protections in State Health Insurance Exchanges

Samuel Salganik, Elisabeth Ryden Benjamin, Arianne Slagle, Marissa Geoffroy

Summary: Under the Affordable Care Act (ACA), millions of consumers will use state-based Health Insurance Exchanges to enroll in coverage. Adopting a robust system of consumer protections will be pivotal to the success of these Exchanges. The report uses the enrollment experiences of two illustrative consumer family configurations to identify how a user-friendly Exchange should work. These scenarios reveal the problem that consumers potentially face three dueling appeals as their eligibility for premium tax credits and Medicaid is processed by an Exchange: (1) a state-based Exchange appeal; (2) a Medicaid Fair Hearing; and (3) a federal appeal under Section 1441 of the ACA. The report makes a series of recommendations that will reduce the need for appeals in the first place by building strong upfront consumer protections in the Exchange and concludes with recommendations for designing a streamlined appeals mechanism.

Issues: Access to Health Care