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Health Insurance Exchanges under the Patient Protection and Affordable Care Act in Washington

The Patient Protection and Affordable Care Act, signed into law by President Barack Obama on March 23, 2010, had the states busy planning and formulating their health insurance exchange. The establishment of this one-stop shop is a major provision in the health reform law. Each state can choose how to run it: whether it will be state-based (but their plan must be approved by the U.S. Department of Health and Human Services or HHS, under Department Secretary Kathleen Sebelius), federally-managed, or run in partnership with the government.

Washington is one of the states that has decided to run its state-based health insurance exchange. Here are four facts about its exchange.

Fact 1: Washington will run its state-based health insurance exchange called the Washington Healthplanfinder.

Washington's Democrat Governor, Christine Gregoire, signed into law Senate Bill 5445 on May 11, 2011. The decree established the creation of the Washington Health Benefit Exchange, which later on was decided to be named the Washington Healthplanfinder. The exchange will be overseen by an 11-member board that would include the Insurance Commissioner and the Administrator of the Health Care Authority. The other nine, who should have proven their expertise in the various fields of insurance care and administration, is appointed by the Governor. The Washington Healthplanfinder will run as a "self-sustaining public-private partnership separate and distinct from the state". The Board had its first meeting in January 2012 and took over the Exchange on March 15, 2012.

Prior to the creation of the Washington Healthplanfinder, the Washington Health Care Authority initiated studies on how to best implement the state's exchange. It recommends setting up liaisons with all stakeholders including holding consultations with American Indian Health Commission. The Board has since established ties with customer advocates as well as representatives of insurance and health care providers. It also has a Tribal representative to give voice to American Indians' concerns.

Fact 2: Residents of Washington can start enrolling in the Healthplanfinder starting October 2013.

With the Washington Healthplanfinder in place, residents can start shopping for plans beginning October 1, 2013. The health insurance marketplace is set to open on that day based on the timetable approved by the U.S. Department of Health and Human Services. All the other requirements of the Affordable Care Act is determined to take full effect by January 1st 2014.

Fact 3: Healthplanfinder offers several novel advantages to the residents of Washington.

The Healthplanfinder will feature qualified health providers (QHPs) in its marketplace. For insurance companies and health providers to qualify, they must first conform to the requirements specified in the Affordable Care Act. These include provisions that have never been mandated by law before. One of these is the accounting requirements set by the government on insurance companies. Previously, companies need not make public how they spend customers' premiums (what consumers pay for their plan). Now with the ACA, companies must follow the 80/20 rule. Known as the Medical Loss Ratio or MLR, this means that companies must allot 80% of premiums to insurance care and use only 20% for salaries and other administrative costs. This gives customers greater assurance that their money will indeed work for them. Aside from this, the ACA requires that people with pre-existing conditions be allowed to avail of insurance; those with pre-existing conditions have previously been "uninsurable". Other first-time benefits to be made available to customers under the Affordable Care Act are the following: provision for preventive care services, which was usually a cash-out option; extension of family health coverage to children under age 26, which before was set at age 18; and removal of lifetime limits.

Fact 4: Thousands of Washington residents will be benefitted by the health insurance exchange.

Once the exchange opens, hundreds of thousands of residents from Washington are estimated to benefit from the ACA. This includes around 758,000 non-elderly uninsured residents, who may receive tax credits to buy insurance. There are also an estimated 62,000 young adults who can get coverage based on the increase in age cut-off for children under the family health plan, as well as more than 1.6 million residents who can avail of preventive care services with no additional cost-sharing. This will be beneficial as well to 1,095,830 women in Washington who will be able to access breast cancer or cervical screenings and other vital preventive services without cost-sharing. Indeed, immeasurable are the benefits, and countless are benefited.

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