Monday鈥檚 release of on the oft-talked about health insurance sparked a feverish 244-page read by bloggers who are聽now exchanging their own ideas on just what the regs will mean for the health law, for employers and for people looking to buy health insurance online.
Here鈥檚 what some of them are saying:
At the Health Affairs Blog, Timothy Jost has three posts: 1) an of the proposed regulation, 2) how the exchanges will health plans and 3) a look at proposed rule released Monday on reinsurance and risk adjustment programs.聽Jost聽thinks the regulation makes it clear that the federal government 鈥渞eally wants the states to run the exchanges, and will go far to work with them to make this happen. HHS cannot, however, change the terms of the statute and insofar as many states object to the ACA for political reasons, continues to face a difficult task in getting them on board.聽 There will be a federal exchange and HHS will have to tell us what it will look like.鈥�
At , Matthew Holt talks with Michael Sandwith, a company official with ACS, a company that will be helping run insurance exchanges, on why companies like his should help run exchanges for states. His reason? 鈥淏ecause they鈥檝e done it before,鈥� Holt writes.
At , Igor Volsky believes that health insurers are聽鈥減ressuring government to transform exchanges into an automated yellow pages.鈥� He adds:聽鈥淎llowing every insurer into the new marketplaces may do wonders for the industry鈥檚 bottom line, but it can鈥檛 be the best solution for enrollees. As former Massachusetts exchange head Jon Kingsdale often observes, letting every payer in 鈥渨ould be like telling your grocery store they have to offer聽every single kind of bread聽baked by every single bakery.鈥�
At the Georgetown University Center for Children and Families鈥� blog, Joe Touschner writes that much of the details still have to be worked out, leaving many to 鈥渟quint.鈥� 鈥淭his proposal doesn鈥檛 address how families will qualify for the tax credits that will help make exchange coverage affordable, nor does it cover what the minimum benefit package will look like.鈥�
John Goodman, at his points out聽an interesting use of language in the proposed regulation by quoting聽an e-mail from Chris Jacobs, a health policy analyst at the Republican Policy Committee: 鈥淲hile the Administration is trying to sell Exchanges聽as providing competition and flexibility, the 347 pages of regulations contain the word 鈥渞equire鈥� a whopping 811 times (628 instances in the Exchange regulation, and 183 in the risk adjustment regulation).聽 It鈥檚 worth asking: 聽How flexible can a piece聽of regulation that has 811 separate references to mandates and聽requirements be?鈥�
At , The Heritage Foundation鈥檚 blog, Edmund Haislmaier says the regs are 鈥渓ess than meets the eye鈥澛爓hen it comes to state flexibility: 鈥淔or example, state lawmakers are particularly concerned about how Obamacare gives the exchanges control over Medicaid eligibility. Some are considering establishing an exchange mainly to retain state control over Medicaid 鈥�.鈥�
At , Henry Stern does the math on what the exchanges will cost taxpayers: 鈥淥f course, it鈥檚聽literally聽鈥榶our tax dollars at work,鈥� since 鈥榌t]he Congressional Budget Office predicts that by 2019, about 24 million people will have insurance through exchanges, with four-fifths of them getting federal subsidies that average $6,400 a year per person.鈥� [emphasis added]鈥�
The New York Times鈥� blogger聽Robb Mandelbaum looks at how employers might do the math and how regulations will affect how they聽might decide to cover their workers 鈥撀爋r not. 鈥淭he Affordable Care Act requires that insurance purchased on the exchange deliver certain minimum benefits, but it is silent about whether large employer plans will have to meet the same standards. 鈥� The government, [one analyst] said, will have to address this in the regulations that flesh out the law. If the requirements for exchange plans are more stringent than those for employer plans, they will probably cost more, which would make it harder for the raise an employer offers in place of coverage to meet the cost of buying coverage on the exchange.鈥�