|By Kristi L. Nelson, The Knoxville News-Sentinel, Tenn.|
|McClatchy-Tribune Information Services|
This is what the health care insurance marketplace is supposed to look like next year, according to standards set by the Affordable Care Act, passed in 2010. A small part of the far-reaching health care reform act deals with so-called "exchanges," new ways to simplify buying health insurance and make it affordable for more people.
All about exchanges
Under the ACA, each state will have its own exchange, sometimes referred to as the "health insurance marketplace," with several health plans available from various private and nonprofit companies. Though the coverage won't take effect until
The federal government gave states three options for setting up the exchanges. States could choose to implement their own exchanges, making all decisions on coverage and administration within certain federal guidelines. Or they could forfeit this right and let the federal government run its "default" exchange in the state, charging the state a percentage of premiums. Or states could "partner" with the federal government, using the standard federal exchange but administering some parts of it through state government.
Yet at the federal government's
"There would be significant risk involved with taking on an exchange while your department is still developing the rules of the game or if the federal government is ultimately going to control the more important levers," Haslam said in a letter informing U.S. Secretary of Health and Human Services
And while several groups have speculated that a state-federal hybrid exchange isn't completely off the table, Haslam's office declined to address that specifically. Spokesman
The different types of exchanges work basically the same way. But states that establish their own exchanges can decide which insurers can participate, while the federal exchange will accept any plans that meet guidelines. State-established exchanges also could put more emphasis on certain benefits.
Who will use the exchanges?
At first, only individuals and employees of companies with 100 or fewer workers can buy insurance on the exchanges. Most people will be eligible for subsidies to help them pay their premiums. Most Americans will still get insurance through their employers. Undocumented immigrants cannot buy insurance through the exchanges, nor would they qualify for