NASW Submits Comments on State Health Insurance Exchanges – An Essential Feature of the 2010 Affordable Care Act

The Affordable Care Act (ACA) stipulates that by 2014, each state will have an “exchange,” a health insurance marketplace for individuals and small businesses.  Exchanges should provide many currently uninsured and underinsured Americans with an affordable way to obtain comprehensive health coverage.  According to the ACA, individuals can purchase coverage through their state exchange if their household income exceeds the maximum for Medicaid eligibility, but is less than 400 percent of the federal poverty level.   Federal subsidies will help defray the premium costs for lower- and middle income individuals and families.  Businesses with up to 100 employees are also eligible to purchase coverage through the exchanges.  Using federal guidelines, each state will develop and operate its own exchange, or join a regional exchange.  If a state does not implement its own exchange, the Secretary of Health and Human Services (HHS) will set one up for that state.

The Centers for Medicare & Medicaid Services (CMS) recently requested public comment on how state health exchanges – and the health plans offered within them – should operate.  NASW argued persuasively for consumer protections in the exchanges – and for the inclusion of professional social workers as providers in all health plans that are offered through the exchanges. Read NASW’s comments.

HHS announced this week that the comment period for the proposed rules on the exchanges has been extended to OCTOBER 31, 2011.   (The previous deadline was September 28, 2011.)

We encourage you to review the proposed rules [!documentDetail;D=HHS-OS-2011-0020-0001]  and submit your own comments.


  1. The Health Insurance Exchanges should be expanded across states, rather than merely restricted to states. For example, here in Florida, we have a higher proportion of elderly, hispanic and haitian populations, creating a more expensive risk pool. This drives premiums higher. The competition within Florida thus becomes more restricted.

    Allowing for portability of health insurance plans across state borders will allow the market competition to widen, thus allowing for greater savings in premiums across the nation. This allows each citizen a better choice for health coverage, rather than the choice to stay or move in their state.

  2. It is always a good idea to have your say when the government asks for it. I commend you on getting the word out there so that more people express their thoughts and opinions as the rules around how the exchanges will work are formed. Whether or not parts/all of the PPACA is revised or overturned, exchanges are on their way whether they be public or privately run. I also think it is important for corporate plan sponsors and the broker community to start thinking about the Pay or Play decision to be made. My recent blog entry talks about this decision process.

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