A new report examines how states can create health insurance exchanges, mandated under the Affordable Care Act, to provide Web-based one-stop shopping to individuals and small businesses to compare health benefit plans and purchase coverage.

The Center for American Progress, a Washington-based nonpartisan research and educational institute; and the Small Business Majority, a not-for-profit research and advocacy firm, developed the report. It lays out basic principals to consider when creating an exchange, five important decisions that will determine the shape and structure of the exchange, ways to maximize participation, and critical issues to confront.

Those issues include whether to establish separate individual and small-employer exchanges or merge them, the role of insurance brokers and compensation for their services, whether employees can choose their own health plan or if an employer can choose a single plan, and being competitively priced, among others.

"We cannot stress enough how important it is for policymakers to think about the topics covered in this paper before they start setting up the exchanges," the report contends. "If they fail to take into account such issues as maximizing participation or making the exchange cost competitive, based on the history of small-employer exchanges and pools, they risk low enrollment and potential failure."

Under the health reform law, states must by notify the federal government by 2013 of their intent to build an exchange and have it operational by 2014. The federal government will step in and develop an exchange in any states that refuse to do so. The report is available here.

Joseph Goedert writes for Health Data Management, a SourceMedia publication.

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