The Washington Health Benefit Exchange: A Key Part of the Post-PPACA Health Insurance Market (2024)

A look at the Patient Protection and Affordable Care Act and WA Health Benefit Exchange.

Now that most of the sound and fury about the constitutionality of the Patient Protection and Affordable Care Act (PPACA) seems to have settled down, it might be a good idea to take a look at the changes it brings. While many of these changes may be of interest mostly to health benefits or other specialty practices, changes to the health insurance market should be of some interest to almost any lawyer. After all, they will in some way affect all of our clients — whether businesses, government agencies, or individuals — as well as lawyer and law firms themselves.

The Health Law Section will be exploring these issues over the coming year, including an upcoming CLE on March 22 (stay tuned for registration info). One of the more significant developments in Washington right now is the development of the Washington Health Benefit Exchange.

Under PPACA, each state is required to set up a health insurance exchange, a sort of clearinghouse for health insurance plans provided directly to individuals and businesses. An exchange will not supersede government programs like Medicare and is supposed to complement employment-based health insurance. If a state does not set up an exchange, the federal government will do it for them; Washington has chosen to do so, and staff, volunteer advisors, and committee members are now tackling the wide range of issues and processes needed to make it work.

According to Barbara Flye, senior health policy advisor in the Office of the Washington State Insurance Commissioner, open enrollment for plans offered through the Exchange is expected to begin Oct. 1, 2013, for coverage beginning Jan. 1, 2014. She expects the Exchange to supplement rather than supplant existing options:

Washington state will have a vibrant marketplace for individual and small group plans both inside and outside of the exchange. So, just like today, if you want to buy coverage, you can go directly to the insurer or work through a broker or agent. The plans sold inside and outside the exchange must meet the same consumer protections. The primary differences are that the advanced tax credits and cost-sharing support is only available for those plans purchased inside the exchange, and the exchange will make comparing and shopping for insurance more transparent, allowing small businesses, individuals, and families to make apples to apples comparisons.

Associations will still be allowed to provide coverage for their members, but many of them will now have to meet the same consumer protections as the rest of the market. For example, in Washington today, associations are allowed to use underwriting in their rating of plans. In 2014, many of these plans will become part of the same community risk pool as the rest of the market and will no longer be able to price coverage based on health status. Others will maintain their association status and continue to operate as a large group.

Benefits details are still in development, and policies that will be offered won’t be filed with the Insurance Commissioner until late spring, so it is not yet clear how many plans will be offered. However, Barbara Flye noted that several insurers have been actively involved with the Exchange. The Exchange is currently developing a website that will include applications guiding consumers and small businesses through their policy choices. Trained “navigators,” as well as agents and brokers, will be available to help as well.

More information can be found on the Washington Health Benefit Exchange website, including information about committee meetings and advisors and the status of various initiatives.