Health Insurance Exchanges

On January 1, 2014 Wisconsin residents will be able to purchase their health insurance coverage through Health Insurance Exchanges. Exchanges provide a forum for individuals and small businesses to compare and purchase private health insurance plans.

The Affordable Care Act requires the U.S. Department of Health and Human Services to establish initial guidelines on the creation of the exchanges and what basic components a product must have to qualify for this new venture. However, states retain a great degree of flexibility in how exchanges operate, what benefits products can or should include beyond the federal floor, and how patients and physicians interact with insurers and their products within the exchanges.

The Wisconsin Academy of Family Physicians has lobbied the Wisconsin Office of Health Care Reform to encourage its consideration of the following principles in developing health insurance exchanges:

• Fair representation of stakeholders
• Payment for the Patient-Centered Medical Home and enhanced access
• Standardized contracting
• Set primary care targets
• Require robust primary care-based essential benefits
• Presume eligibility
• Reward quality
• Protect consumers