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New Health Exchange Rules Show Important Improvements

Health reform took a major step forward this week, as the Department of Health and Human Services (HHS) released the final rules detailing the standards for the health insurance exchanges that the Affordable Care Act calls for.

These competitive marketplaces are a centerpiece of health reform and will give individuals, families, and small businesses multiple options of private health insurance plans that meet basic standards.  States planning to set up their own exchanges now have much of the information they need to move forward.

While we are still reviewing the new rules, several improvements since HHS’s initial proposals are worth highlighting.

  • The final rules strengthen the standards for “Navigators” — entities that are supposed to provide, with funding from the exchanges, accurate and unbiased information to consumers about available health coverage options.  The final rules require exchanges to develop conflict-of-interest and training standards for Navigators.  And, while it was already clear that health insurance companies could not serve as Navigators, the final rules state that associations that include insurers or lobby on their behalf cannot be Navigators either.  Meanwhile, Navigators cannot receive compensation from an insurer for enrolling individuals or employees in any health plan, including plans available outside the exchange.
  • Under HHS’s proposed rules, a family’s income would have to drop by 20 percent from what was on their prior tax return before the exchange would take that decrease into account in determining the amount of help the family would get to pay premiums.  Rightly recognizing that this approach would make coverage unaffordable for many families, the final rules allow exchanges to take all income declines into account.  As a result, people who need help paying their premiums are far more likely to get the right amount of assistance.
  • The final rules require exchange governing boards both to include at least one voting member who represents consumer interests and to ensure that insurers and other parties with a conflict of interest do not make up a majority of the board.  We hope that states will go beyond these minimum standards and further strengthen consumer representation on their exchange boards.