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Health Insurance Exchanges

Technical Assistance | Reports and Presentations | Workshops | Request Assistance

Through its work over the past decade, IHPS has earned the reputation as a leading expert in the design, development, and operation of health insurance Exchanges.

Our work has often focused on the development of small employer Exchanges offering worker choice of health plans, often under the auspices of not-for-profit organizations with employer/consumer boards of directors or of independent state agencies and boards.

We are now assisting several States and others in the design, development and implementatin of Exchanges under recently enacted federal health reforms.

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Technical Assistance
IHPS staff have significant experience in the design, development, and operation of health insurance Exchanges. Our focus is to assist with the design of Exchanges that combine public subsidy funds with private contributions to cover the uninsured. As part of this work, we can assist with:
  • policy work on the federal and state level to support the development of Exchanges;
  • the development of feasibility analyses ;
  • design of program structures, including the development of participation rules and health plan offerings;
  • development of rating structures and subsidy schedules that result in affordable access and equitable treatment of lower income workers while protecting against adverse market forces;
  • identification, criteria evaluation selection of insurers and administrative vendors; and
  • insights and information for educational and outreach materials.
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Reports and Presentations

Recent Presentations

HS Stakeholder Conference on Exchanges.

In August 2010, HHS hosted a conference on Exchange implementation issues. To see the video from that conference, click here. Once there, you may scroll down to Panel 4 to view the panel discussion on Exchange functions, in which IHPS's Rick Curtis participated.

Presentation by Rick Curtis to National Association of Insurance Commissioners, Health Care Reform Implementation Interim Meeting, Exchanges (B) Subgroup, Washington, D.C., July 22, 2010.

"Health Reform: What Legislators Need to Know about Exchanges," Presentation to a National Conference of State Legislators Webinar, June 2, 2010. Slides.
NCSL Webinar page with link to audio.

"Structuring Exchanges: An Overview of State Issues and Options," Presentation via Video Conference to a legislative briefing by the Evidence-Based Health Policy Program, University of Wisconsin Madison, May 27, 2010.

"Exchange Goals, Options and Considerations," Presentation to Alliance for Health Reform Session on "Health Insurance Exchanges: See How They Run," Washington, D.C.: May 11, 2009. Slides.
Alliance briefing summary page with link to video.

Recent Reports

"Tobacco Rating Issues and Options for California under the ACA" (IHPS, June 21, 2012).

This issue brief illustrates the potential impact of the federal Affordable Care Act (ACA) provision which allows health insurers to charge up to 50% more for people who use tobacco. This premium surcharge would be paid entirely by the individual, which could mean much larger proportionate (and potentially prohibitive) cost increases for lower income individuals. However, the ACA allows states to impose stricter standards for such market rules. Therefore, States could choose to disallow tobacco rating entirely or limit the tobacco-rating factor to lesser amounts. The brief identifies and assesses the implications of several alternative approaches states might adopt. Thanks to the California HealthCare Foundation for funding this analysis.

"Continuity for (Former) Medi-Cal Enrollees and Affordability for the Low-Income Exchange Population: Background and an Alternative Approach"(IHPS, June 29 2011)

Under federal health reform, adults whose incomes cross the line dividing Medi-Cal (Medicaid) from Exchange tax-credit eligibility could face substantial impediments to continuity of care, because the provider networks and associated costs in Medi-Cal and private-market health plans are often very different. Further, the sliding scale contributions required for Exchange coverage could be problematic for recently poor people whose resources have been depleted.

This report assesses several alternatives that might improve the continuity and affordability problems faced by this population. It assesses implications of full Exchange participation of Medi-Cal plans and their provider networks, including potential access or cost problems for other Exchange enrollees. It also assesses the Basic Health Program (BHP) option, which could improve continuity and affordability for former Medi-Cal enrollees, but also presents considerable downside risks regarding funding levels, substantial reductions in the Exchange's reliable "core" enrollment of tax credit recipients, and potential continuity of care limitations for a number of individuals.

The report also presents an alternative approach that could achieve continuity and affordability goals without these downside risks. It would involve limited participation in the Exchange by Medi-Cal plans to allow for continued affordable coverage for persons changing from Medi-Cal to Exchange coverage, and for an affordable "essential community provider plan" option for all low-income Exchange enrollees.

Small-Employer ('SHOP') Exchange Issues in California (IHPS, March 2011)

New Paradigm Plans (IHPS, July 2011)

"Designing Health Insurance Market Constructs for Shared Responsibility: Insights from California." Health Affairs, 24 March 2009

Health Affairs subscribers can access this article here.

Others can access this article (and two related articles) through the California Healhcare Foundation's website by clicking here.

What Health Insurance Exchanges or Choice Pools Can and Can't Do About Risks and Costs (IHPS, May 2009)

Exchanges / Pools as Mandated Coverage Venues

An Implementation and Alternate Scenario Analysis of California's Health Insurance Act of 2003 (SB2) (IHPS, April 2005)

Exchanges / Purchasing Pools as Vehicles for Subsidies

Three Options for Insuring all Californians (California HealthCare Foundation, October, 2006)

Massachusetts-Style Coverage Expansion: What Would It Cost in California? (California HealthCare Foundation, April 2006)

The Potential for a Small-Employer Purchasing Pool in Wisconsin: Issues and Options for Overcoming Barriers to the Development of the Private Employer Health Care Coverage Program (PEHCCP) (IHPS, January 2003)

Private Purchasing Pools to Harness Individual Tax Credits for Consumers (The Commonwealth Fund, December 2000)

Potential Tasks for Implementing Premium Assistance through a Consumer Choice Health Purchasing Group (IHPS, May 2000)

Coordination of Title XXI Coverage with Employer-Based Coverage through Consumer-Choice Health Purchasing Groups (IHPS, January 1999)

Resource Documents and Other

Consumer-Choice Purchasing Pools: Past Tense, Future Perfect? (Health Affairs, January/February 2001)

Creating Consumer Choice in Healthcare: Measuring and Communicating Health Plan Performance Information (IHPS, March 1998) Includes: "The Necessary Ingredients for a Consumer Choice Purchasing Group"

Medicare Consumer Information and Risk Selection - The Feasibility of Medicare Consumer Cooperatives (IHPS, March 1997)

A Guide to Facilitating Consumer Choice (Health Affairs, Winter 1996)

Medicaid and Cooperative Healthplan Purchasing Organizations (IHPS, December 1996)

Health Network and Alliance Status Report: Cooperative Health Care Purchasing Strategies in the Era of Accountability (IHPS, 1995)

Health Network and Alliance Status Report: Cooperative Health Care Purchasing Strategies in the Era of Accountability (IHPS, 1995)

Resource Manual: Implementing Healthplan Purchasing Cooperatives (IHPS, 1995)

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Academies and Workshops
Purchasing Pools to Reach Uninsured Working Families (May 2000)
Blazing the Consumer-Choice Trail (April 1999)
A Matter of Choice (May 1998)
Spanning Diverse Puchasing Roles (May 1997)
Developing Measures for Quality (May 1996)
Medicaid and Cooperative Healthplan Purchasing Organizations (December 1996)
Harnessing the Power of Consumer Choice (July 1995)
Tailoring Healthplan Purchasing and Choice Strategies for Your Market (December 1995)
Purchasing Strategies for Better Value, Service and Accountability (December 1994)
Putting Health Purchasing Alliances into Action (June 1993)
Implementing Alliances and Cooperatives: What to Do and How to Do It (May 1994)

Request Assistance
Contact IHPS for additional information.
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