National Harbor, Md. – Gary Cohen, director of the Center for Consumer Information and Insurance Oversight (CCIIO), told a panel of state insurance regulators that the U.S. Department of Health and Human Services (HHS) “will be able to open our doors” on Oct. 1, 2013.
HHS will be able to operate a health insurance exchange in every state that is not able to operate an exchange in time for open enrollment, Cohen said.
“Ten months from today, people will be signing up for health insurance,” Cohen said. “Many will have not had health insurance or will have had it and lost it.”
The federal exchanges will charge plans a user fee of up to 3.5 percent of premiums on qualified health plans that are part of the federal exchange, and the state-based exchanges will find their own solutions for revenue, Cohen said.
HHS will also provide consumer support with a live chat system and a call center, and it is building a website so that consumers can compare plans and enroll in a qualified health plan, he said.
The Centers for Medicare & Medicaid Services (CMS) is building a data services hub, and it has completed the technical design for that project, Cohen said. The hub is now in the testing phase, Cohen added.
States will be the primary exchange regulator but the CMS is ready to take on enforcement, Cohen told state regulators.
The federal government is ready to take on enforcement of health insurance activities within the health care exchange if a state is unable to enforce program rules or does not, or if it asks HHS to help with enforcement, Cohen said.
Cohen spoke at the National Association of Insurance Commissioners fall meeting, before the NAIC Health Care Reform Regulatory Alternatives Working Group.
The working group is chaired by Pennsylvania Insurance Commissioner Michael Consedine. The members are states that, by and large, have not moved far with efforts to create state-based exchanges. The Patient Protection and Affordable Care Act (PPACA) — the federal health care reform law — requires regulators to give consumers access to a state or federally facilitated insurance marketplace for health care.
Cohen said much new guidance is expected in the next couple of weeks from HHS. Regulators expect rules on navigators to be out in January, he said.
Cohen also said there is a new grant deadline of Dec. 28 for states that envision a state exchange or even a federally facilitated exchange that would transition into a state exchange.
He noted that former Oregon insurance commissioner Teresa Miller, acting director, Office of Oversight for CMS, has been doing outreach on this element with states, but he assured state regulators they would still be the primary regulators of insurance.
If PPACA takes effect on schedule and works as drafters expect, it will require insurers to sell coverage on a guaranteed-issue basis starting in 2014. Insurers will have only a limited ability to take a consumer’s age or health into account when setting rates.