September 30, 2012 is the "soft" date of the "essential benefit" benchmark for the states in the Affordable Health Care Act, both inside and outside market reforms.
Affordable Health Care Act - Full Implementation by January 1, 2014
What does that mean? It means that according to federal law, the individual mandate says each Wisconsinite should have qualified health care insurance coverage. It means Health Care Exchanges should be in place and covering various items with specific and/or uniqueness of coverage that the law requires - reforms, benefits, pre-empted state laws, exceptions, actuarial value (bronze-silver-gold-platinum-catastrophic plan), medicaid expansion, reinsurance (3-year program/millions of $$), risk corridors, risk adjustment, subsidies, individual/employee mandates, co-op and multi-state plans.
For example, for those folk with up to 400% below poverty, there are subsidies; however, the subsidies are of no value if the exchanges (products for coverage) are not in place. This means the "in-house exchange" and outside market reforms are necessary.
What are the rates, plans?
What are the requirements - procedures and processes for coverage?
There are three (3) Exchange options of leadership in the Affordable Health Care Act. They are:
- State Exchange.
- operated by the state
- may operate risk adjustment
- determine eligibility for subsidies
- Federal Facilitated Exchange (if the state refuses the US GOV HHS will make the decision and operate the Exchange
- Partnership Exchange
- HHS operate Exchange
- state makes key decision, does plan management and some consumer assistance
What are the market reforms that must be known by the state, insurance carriers and Wisconsinites? They include:
- guarantee issues
- rating issues
- essential benefits
- no annual limits
- no life-time limits
- September 30, 2012 - Essential Health Benchmark
- November 16, 2012 - Applications Due
- January 2013 - HHS Certifies State Exchanges
- October 2013 - Initial Open Enrollment Period
- January 2014 - Exchange Coverage Effective
- Establishment Grants - Available through 2012
- Your individual legislators office (senator and representative)
- Governor Scott Walker
- Secretary Ted Nickel - Office of Commissioner of Insurance
- Secretary Dennis Smith - Department of Health Services
- Secretary Reggie Newson - Department of Workforce Development
Most of the information of this article was taken from a briefing given by Brian Webb, Manager of Health Policy & Legislation, National Association Insurance Commissioners.