The Affordable Care Act (ACA) created a system of healthcare exchanges that, according to the U.S. Department of Health and Human Services (HHS), are designed to be “state-based competitive marketplaces where individuals and small businesses will be able to purchase affordable private health insurance.” The exchanges (or “marketplaces”) are supposed to make it easy for small businesses and individuals to compare healthcare plans, receive answers to their questions, find out whether they are eligible for certain tax credits and/or health programs, and enroll in a healthcare plan that works for them.
According to guidance from the Center for Consumer Information and Insurance Oversight (CCIIO), the exchanges should:
• Promote efficiency;
• Avoid adverse selection;
• Streamline access and continuity of care;
• Engage in public outreach and stakeholder involvement;
• Be responsible for public accountability and transparency; and
• Have financial accountability.
The exchanges are also connected to ACA’s provisions related to health insurance premium tax credits and Medicaid eligibility.
Health insurance premium tax credits. The ACA establishes premium tax credits for certain individuals who are enrolled in a qualified health plan through an exchange. The premium tax credit is intended to assist millions of middle-class Americans in purchasing affordable health insurance.
Medicaid eligibility. The ACA is designed to expand access to health insurance through improvements in Medicaid, the establishment of the exchanges, and coordination between Medicaid, the Children’s Health Insurance Program (CHIP), and the exchanges.