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PPACA: What can a state do with a federal exchange?

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A group of state insurance regulators is putting the finishing touches on documents that could shape how their colleagues go about implementing the Patient Protection and Affordable Care Act of 2010 (PPACA).

The Health Insurance and Managed Care Committee, part of the National Association of Insurance Commissioners (NAIC), has put drafts of three PPACA implementation guides on its section of the NAIC website.

One deals with how states with “federally facilitated exchanges” (FFEs) run by the U.S. Department of Health and Human Services (HHS), rather than state-run exchanges, might relate to the FFEs.

The others deal with the effects of PPACA on how states relate to the “qualified health plans” (QHPs) sold through exchanges and on how states will regulate the rates of health plans sold outside the exchange system.

In the FFE draft, for example, drafters have included a section on how states with FFEs might interact with exchange navigators and application counselors.

Drafters pose their ideas more as questions to consider than as recommendations for action.

The drafters suggest, for example, that states might want to consider the extent to which they would like to help with the FFE’s outreach efforts; whether and how to license exchange helpers; and the extent to which the state might want to make existing state stakeholder outreach groups available to the FFE for consultation. 

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