Policy Brief Provides Framework for HHS Plans for Insurance Exchanges

The AAFP's Government Relations Division has issued a policy brief (11-page PDF; About PDFs) on the proposed establishment of health insurance exchanges and qualified health plans, or QHPs, to all AAFP chapters to explain how the exchanges are supposed to operate, what they are required to do, and how they could affect family physicians and their patients.

"We are trying to ensure that state AAFP chapters are aware of the broad framework that HHS is proposing for the health insurance exchanges," said Greg Martin, AAFP manager of state government relations. "We want to make sure that AAFP chapters and family physicians are involved with their state's exchanges and are urging that the exchanges and plans being sold on them are primary care- and family physician-friendly."

The state health insurance exchanges essentially are marketplaces where individuals and small businesses can compare and purchase private health insurance plans. HHS is establishing initial guidance on the formation of the exchanges, but states will have flexibility in how the exchanges operate, what benefits will be offered beyond a federally defined minimum, and how patients and physicians will interact with insurers and their products. By law, HHS is required to approve each exchange by Jan. 1, 2013, and the exchanges are scheduled to be up and running by 2014.

The AAFP policy brief provides an explanation of a recently released proposed rule, (62-page PDF; About PDFs) from HHS that provides guidance to states on the structure, governance and functions of health insurance exchanges serving the individual market and the small group market. The rule also provides basic guidance on the accreditation of health insurers and certification of QHPs participating in the exchanges.

According to the policy brief, the proposed rule also sets basic guidelines for state policymakers as they create governing boards for their state's exchange or exchanges. The HHS rule states that the voting membership of governing boards may not be dominated by health insurers, agents or brokers and must have a majority of voting members with "relevant experience in health benefits administration, health care finance, health plan purchasing, health care delivery system administration, public health or health policy issues related to the small group and individual markets."

However, HHS apparently will not require state governing boards to include voting membership specifically reserved for patients and primary care physicians, which is one of the principles the AAFP outlines in its principles for state health insurance exchanges. According to those principles, the AAFP would like exchange governing boards to require at least one seat for consumers and at least one seat for primary care physicians in at least equal proportion to the total number of seats allotted to insurers, specialty medicine, health systems and other stakeholders.

The AAFP will issue comments on HHS' proposed rules for state health insurance exchanges later this year.