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State Health Reform; Insurance; Health Reform


New state health insurance exchanges that are developing under The Patient Protection and Affordable Care Act (ACA) will offer consumers a choice of private health plans known as qualified health plans (QHPs). Under the law, in every state, two of those must be multi-state plans or MSPs. These plans will be administered by the federal Office of Personnel Management (OPM). The MSPs must meet the same requirements as other QHPs. As with other QHPs, people enrolled in the plans will be eligible for premium tax credits and cost sharing assistance if their income is less than 400 percent of poverty or $92,200 for a family of four. OPM, which also administers the Federal Employee Health Benefits Plan, must administer MSPs separately and must contract with both a non-profit insurer and one that does not provide abortion coverage. OPM will negotiate premiums, set rates, establish medical loss ratios and profit margins as well as certify and de-certify plans and make sure they have adequate networks of providers. OPM is expected to release its proposed rule on the MSPs this spring. This paper, based on interviews with federal and state policy makers and others, examines key implementation issues.


Funder: The Commonwealth Fund.

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