NASHP Insurance Marketplace Resources

State-based health insurance marketplaces (SBMs) have emerged as successful models in delivering health insurance to consumers. They consistently outperform other states that use the federal platform in areas of enrollment, affordability, and increased plan offerings and competition. Their flexible structure allows SBMs to focus marketing and outreach efforts and promote policies that generate more health coverage choices at lower costs. The resources below explore the SBM model and how recent state and federal actions are impacting state insurance markets.


Tools

SBM
Performance

Slideshow: State Marketplaces Outperform the Federal Marketplace, April 1, 2019. This slideshows examines how state-based marketplaces outperform the federal marketplace model based on enrollment, affordability, and plan competition.

Chart: Individual Enrollment in Federal and State Health Insurance Marketplaces 2018-2019, April 1, 2019. This chart illustrates how the three marketplace models performed in every state between 2018 and 2019.

Blog: Is New Jersey’s Conversion to a State-based Insurance Exchange a Harbinger?, April 1, 2019. This blog explores why states like New Jersey are considering converting to a state-based marketplace model.

Blog: State-based Exchange Directors Share their Marketplace Success with Congress, March 11, 2019. This blog explores topics shared by marketplace executives with Congressional leaders during a series of meetings in Washington, DC.

State-based Marketplace Resource List, March 6, 2019. State-based marketplace (SBM) resources highlight strategies to support market stability and affordability, the 2019 enrollment period, and how state flexibility enables their success.

Blog: State-based Marketplaces Open for Business, Dec. 19, 2018. This blog describes how SBMs are still at work, even in light of a federal district court ruling striking down aspects of the Affordable Care Act. Includes information on enrollment deadlines for each state.

Blog: How Massachusetts SHOP-ed for a New Small Group Marketplace, May 1, 2017. This blog describes how Massachusetts leveraged Washington, DC’s marketplace technology to create a joint platform for its Small business Health Options Program (SHOP).

Transitioning to an SBM

Blog: So You Want to Build a State-based Marketplace? Here’s How! — Advice from Marketplace Leaders, May 21, 2019. This blog highlights advice from state-based marketplace (SBM) leaders about how to transition to the SBM model.

Webinar: So You Want to Build a State-based Marketplace? Here’s How! May 10, 2019. During this webinar, state-based marketplace (SBM) leaders from Idaho, Massachusetts, Nevada, and Washington, DC discuss what states should know if they’re considering transition to the SBM model

Blog: Is New Jersey’s Conversion to a State-based Insurance Exchange a Harbinger?, April 1, 2019. This blog explores why states like New Jersey are considering converting to a state-based marketplace model.

Q&A Nevada’s Insurance Director Talks about Transitioning to a State-based Marketplace and Saving Millions, April 24, 2018. Q & A with Heather Korbulic, Executive Director of Nevada’s Marketplace, about the decisions driving Nevada’s conversion to the SBM model.

Blog: How Massachusetts SHOP-ed for a New Small Group Marketplace, May 1, 2017. This blog describes how Massachusetts leveraged Washington, DC’s marketplace technology to create a joint platform for its Small business Health Options Program (SHOP).

Issue Brief: Building a More Efficient Marketplace: Lessons from DC Health Link’s Experience with Open Source Code, March 21, 2016. Issue brief detailing the savings and efficiencies generated from Washington DC’s conversion to an open source system for its marketplace.

Federal Impact on Markets

Blog: Annual Federal Insurance Rule Includes Proposals to Address Prescription Drug Cost, Feb. 11, 2019. This blog details the ways the 2020 Notice of Benefit and Payment Parameters proposes to address prescription drug costs through changes in benefit requirements and limits on coupons for prescription drugs.

Chart: Deadline Looms for State Comments on Fed’s Latest Insurance Rules, Jan. 29, 2019. This chart contains details of all the federal changes to insurance market regulations proposed under the 2020 Notice of Benefit and Payment Parameters.

Blog: New Federal Health Reimbursement Proposal Adds New Variables to State Health Insurance Markets, November 6, 2018. This blog describes how proposed regulations grant additional flexibility over the administration of Health Reimbursement Accounts (HRAs).

Blog: Administration Proposes Significant Policy Changes for State Insurance Markets through New 1332 Waiver Guidance, Oct. 23, 2018. This blog explains how new federal guidance changes the requirements for states under section 1332 State Relief and Empowerment Waivers.  

Blog: Lower Cost, Short-Term Insurance Plans Approved, but at What Cost to State Markets and Consumers, Aug. 7, 2018. This blog summarizes changes to federal regulations governing short-term limited duration insurance plans, state actions to regulate these plans, and what implications these changes may have for states’ markets.

Blog: The New Association Health Plan Rule: What Are the Issues and Options for States, June 26, 2018. This blog details all the changes made under a new federal rule regulating association health plans (AHPs)

Blog: New Insurance Rules Allow States to Revise Marketplace Coverage as Rate-Filing Deadlines Near, April 17, 2018. This blog provides a detailed summary of changes made by the 2019 Notice of Benefit and Payment Parameters, the federal rule governing health insurance in 2019.

Blog: How Elimination of Cost-Sharing Reduction Payments Changed Consumer Enrollment in State-based Marketplaces, March 20, 2018. This blog provides an update on how state regulators adjusted their insurance markets in response to the federal decision to eliminate funding for the cost-sharing reduction program. An accompanying chart documents resulting shifts in enrollment by metal level in state-based marketplace states.

SBM Responses to Federal Actions

Blog: State-based Exchange Directors Share their Marketplace Success with Congress, March 11, 2019. This blog explores topics shared by SBM executives with Congressional leaders during a series of meetings in Washington, DC.

Letter: State Exchange Leaders Express Concern about Potential Rule Changes, February 19, 2019. Letter from 13 SBM executives to the U.S. Department of Health and Human Services regarding changes proposed under the 2020 Notice of Benefit and Payment Parameters.

Letter: Twelve State-based Exchanges Outline Strategies to Stabilize Individual Market, August 29, 2018. Letter from 12 SBM executives to the Senate Health, Education, Labor and Pensions Committee detailing consensus strategies to bring stability to the individual insurance market.

Letter: State-based Marketplace Directors Ask Senate Leaders to Support a Reinsurance Program, February 6, 2018. Letter from 10 SBM executives to the Senate Health, Education, Labor and Pensions Committee to support Congressional efforts to stabilize insurance markets.

How States Stabilize Markets

Webinar and Blog: State Reinsurance Programs Lower Premiums and Stabilize Markets — Oregon and Maryland Show How, Dec. 11, 2018. This blog describes early results from Maryland and Oregon’s implementation of a reinsurance program for their individual insurance market. Additional details are shared in a webinar linked in this blog.

Blog: Health Coverage and Human Service Program Eligibility: Considerations for States Weighing Systems Integration, Oct. 2, 2018. This blog describes various policy considerations for states that are interested in implementing more integrated eligibility systems for their health and human services programs.

Blog: How State Policymakers Spent Their Summer: Stabilizing Their Insurance Markets, Sept. 11, 2018. This blog provides a round-up of new state legislation passed to implement an individual mandate and to regulate short-term insurance and association health plans.

Blog: #NASHPCONF18: Policymakers Share Their Approaches to Stabilize State Individual Insurance Markets, Aug. 28, 2018.  This blog recaps a NASHP conference panel with state officials highlighting strategies used to stabilize markets and identify lingering challenges to insurance markets’ affordability and choice.

Blog: #NASHPCONF18: State Policymakers Share Views on Evolving Individual Insurance Markets, Aug. 21, 2018. During NASHP’s 31st Annual State Health Policy Conference, experts and state officials assessed the dramatic sea changes that recent federal action has imposed on their individual health insurance markets, what they are doing to stabilize them, and what the future holds.

Webinar and Blog: Ministry, Association, and Short-Term Health Insurance Plans – What’s a State to Do? May 29, 2018. During this webinar, experts reviewed major trends expected for insurance markets, and state actions and tools to encourage stability and consumer protections in the midst of these changes.

Blog: States Face Short Deadlines to Address the Risks of Short-term Insurance Plans, May 1, 2018. This blog reviews options for state regulation of short-term insurance plans in light of proposed federal rules to expand their availability.

Q&A with Pennsylvania’s Insurance Chief: Jessica Altman Explores the Evolving Role of Insurance Coverage, April 10, 2018. Altman speaks with NASHP about the evolving role of health insurance coverage in state and national politics.

Webinar: How Would a State Individual Insurance Mandate Work? Feb. 7, 2018. This webinar dives deep into Massachusetts’ individual mandate and a new proposal in Maryland to create an auto-enrollment process for individuals through its insurance marketplaces.

Webinar: Prohibiting Discrimination under the Affordable Care Act—State and Federal Roles and Responsibilities, April 18, 2016. This webinar examines the state role in prohibiting discrimination in health insurance coverage per requirements issued under the Affordable Care Act including the impacts of nondiscrimination requirements on insurance markets.