What Does A Federal Insurance Exchange Look Like? Less Transparent.

The New York Times published an article on August 4 that discusses some of the difficulties facing states and governors who have decided to let the federal government run their health insurance exchanges.  With 13 states already in the process of developing their own exchanges, the article says the federal government plans to run insurance exchanges in about half of the states that opt out.

Among many uncertainties associated with what a health insurance exchange will look like is an issue with the level of transparency being practiced by the federal government and its definition of terms like network adequacy and essential health benefits.  The article explains:

“Mr. Hash, the director of the federal Office of Health Reform, said the federal exchanges “will operate essentially in the same manner as the state-based exchanges.” However, they differ in a significant way. States have done their work in public, but planning for the federal exchanges has been done almost entirely behind closed doors.”

The articles concludes by shedding light on the concerns of an Idaho Representative.

John M. Rusche, a Democrat who is the minority leader of the Idaho House of Representatives: said he wanted to know “how much of the federal exchange will be standardized and how much will be customized” to the needs of each state.

Mr. Rusche said he also wanted to know how the federal government would decide whether a health plan had enough doctors and hospitals in its network.

In setting standards for “network adequacy,” he said, it would help if federal officials understood the geography of Idaho, where the nearest hospital could be two hours away.

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