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An Exchange of Ideas

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Almost 3 years after Obamacare was signed in to law and there is as much, if not more uncertainty than before. All the campaign promises, “You can keep your plan if you want”, “Your premiums will drop by $2500 (or 3000%)”, and so forth have been proven to be lacking in honesty and integrity.


We are a little more than a year away from the deadline for FULL implementation (1/1/2014) and still the states have no real clue what is expected of them with regard to the exchange.


This should come as no surprise since Washington has arbitrarily usurped the legal authority of the states to set policy provisions, approve contract language, establish reserve requirements, minimum loss ratio standards, as well as setting and reviewing rates.


Confusion abounds.


States, carriers and consumers alike have been left in the dark when it comes to rules, guidelines and interpretation. The law, as written, says one thing, but then the HHS Dept. decides it means something else.


The law applies to everyone equally . . . unless of course you were granted a waiver or exception.


HHS has decided the law even trumps your religious rights and beliefs when it comes to items such as birth control or abortion.


So why should the rules concerning exchanges be any different?


In an open letter to HHS, Gov. Terry Branstad (Iowa) raised several (still unresolved issues and questions) regarding Obamacare and the exchange.

1)     Please provide a complete list of regulations that will have to be reviewed, revised and re-opened for public comment prior to implementation as a result of the Supreme Court ruling (e.g., the Medicaid eligibility regulations, exchange regulations related to interface with Medicaid). What is the schedule for re-issuing these regulations? 

         2)    When will final rules be issued on essential health benefits, actuarial value and rating areas? 

3)     The federal government has already extended deadlines for applying for Level 1 and Level 2 Exchange Establishment funding into 2014. Can we expect extensions of the deadlines for other areas of implementation given the uncertainty caused by the Supreme Court ruling and the linkage between Medicaid expansion and exchange eligibility and enrollment functions? In addition, will the deadlines change for states implementing a partnership exchange? Will the deadlines be extended for states implementing a federal exchange? Can you confirm that states will be able to switch from a federal model to a partnership or state model until 2019 and that funding will be available to enable that transition? 

4)     When will the details of the federal partnership options be available? These cannot be considered as an option without details including cost estimates and how state and federal systems are expected to link. How will the long term funding of the federally-facilitated healthcare exchanges be sustained? 

5)     States considering a state-based exchange need to know whether there will be a charge to use the federal data hub, advance premium tax credit/cost-sharing reduction service, risk adjustment and transitional reinsurance programs. Will there be a charge? And, if so, how much will it be? 

All good questions, along with 45 more on this site.


We were also promised that “Gitmo” would be closed by this president. Almost 4 years later and the prison is still open.


Makes you wonder when, or if, Obamacare in its’ final form, will happen.

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