By Joe Touschner

Since the passage of the Affordable Care Act, we’ve known that state exchanges are a big part of the vision for reforming and expanding health coverage.  Although that vision may have started about a bit hazy, it’s coming into sharper focus.  State policymakers have been passing laws and taking other action to give exchanges their general outlines.  And today, HHS released two proposed regulations that provide some further clarity.  One covers a range of state exchange issues and the other addresses the risk adjustment procedures that will encourage insurers to compete on cost and quality.  They’re a useful start, but you might still have to squint, because several exchange details have yet to be defined.  

Along with today’s proposed rules, HHS released a fact sheet that provides a good overview if you’re not setting aside time to pore through the hundreds of pages of rulemaking.  The proposed rules, on which HHS is seeking public comment, cover:

* The timeline for states to adopt exchanges

* The basic functions of exchanges

* The qualification of plans to be offered through exchanges

* Some of the basics on the streamlined enrollment process

* Initial guidance on navigator programs

* Options for the small business portion of exchanges, and

* The opportunity for states to partner with HHS on some exchange functions.

We’ll be digging in more deeply to understand and communicate the impacts of these rules on kids and families who need quality, affordable health coverage.  But even with these proposed rules, we’re still waiting for more clarity on a number of key concepts.  This proposal doesn’t address how families will qualify for the tax credits that will help make exchange coverage affordable, nor does it cover what the minimum benefit package will look like.  States will also need further guidance on how Medicaid eligibility determinations will change in 2014 to align with exchange processes.  We’re expecting further rulemaking on these and other ACA topics later this year.