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Becky Bowers
By Becky Bowers March 28, 2012

Meet basic requirements, shop on a health care exchange

Updated March 30, 2012

President Barack Obama promised on the campaign trail that "if you don't have insurance, or don't like your insurance" you would be able to choose from a range of private plans the way federal employees do.

The health insurance exchanges created by the Affordable Care Act, which he signed into law in March 2010, will offer such choices in 2014 to people who meet basic eligibility requirements.

The exchanges are being designed primarily to serve small employers and people purchasing their own insurance — both of whom have trouble getting affordable, high-quality plans. Some will qualify for tax credits and cost-sharing reductions to help pay their premiums.  But those exchanges are also open to anyone else who doesn't like their insurance — as long as they're willing to pay the full price of the new policy.

States are working on setting up exchanges now. Beginning in 2017, states will also have the option to allow insurers to offer large-group plans on the exchanges, which means that larger companies could provide those plans to workers.

Meanwhile, workers who already have health insurance through an employer could shop for and enroll in coverage on an exchange. They just wouldn't be eligible for premium tax credits or cost-sharing reductions unless their employer-sponsored coverage was inadequate or unaffordable.

So "if you don't have insurance, or don't like your insurance," you generally will have choices available from an exchange, as Obama promised. (We say "generally," because there are some exceptions. For example, you can"t be incarcerated and you have to be in the country legally. But eligibility is broad.)

We should note that if you already have employer-sponsored coverage, it's unlikely you would choose to foot the full cost of your own policy from an exchange — there's no provision that lets you take your employer contribution with you.

Still, Obama didn't promise everyone would find a better deal on the exchanges, just that they would "be able to choose" from "quality private plans." And the most recent rules under the Affordable Care Act support this statement. We rate this a Promise Kept.

UPDATE: This rating replaces one we published on March 28, 2012. At the time we rated it Compromise. But after that was published, the Department of Health and Human Services clarified that people who already have insurance from larger employers would still be eligible for the exchanges.

Our Sources

Email interview with Erin Shields, communications director for health care, Health and Human Services Department, March 29, 2012

Interviews with Timothy Jost, professor at the Washington and Lee University School of Law, including by email, March 23, 29, 2012

Government Printing Office, The Patient Protection and Affordable Care Act, March 23, 2010

Department of Health and Human Services, "Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers," March 1, 2012, "Affordable Insurance Exchanges," updated Jan. 25, 2012, "A Health Care Marketplace to Help You Find Insurance," Aug. 12, 2011, "2012 Progress Report: States Are Implementing Health Reform," Jan. 18, 2012

Kaiser Family Foundation, "Establishing Health Insurance Exchanges: An Overview of State Efforts," March 16, 2012

Angie Drobnic Holan
By Angie Drobnic Holan January 18, 2011

State-based exchanges will create insurance options

President Obama said many times on the campaign trail that health reform would give people new options to buy health insurance. But the new health care law doesn't match up entirely with Obama's promise that "if you don't have insurance, or don't like the insurance you have, you'll be able to choose a new plan on a health insurance exchange."

The new law created more than one exchange; it created state-based exchanges where consumers can buy insurance starting in 2014. People who earn a modest income but can't get insurance through work will qualify for tax breaks. Small businesses will be able to send employees to the exchange, and, if they wish, give them money to help them buy insurance. Large employers don't have that option; the law envisions them continuing to offer employees insurance without using any type of exchange.

All this means that different people will have different levels of access to the exchanges. Some people will qualify for tax breaks; others won't. Some workers will get help buying insurance from their employers; others won't. We'll be monitoring the exchanges to see how they work when they come online in 2014.

For now, we're moving this promise from Stalled back to In the Works.

Our Sources

Angie Drobnic Holan
By Angie Drobnic Holan November 10, 2009

We add new promise on opening the health exchanges

We've gotten several e-mails from readers who remembered then-candidate Barack Obama giving rousing stump speeches on how his health care plan would allow people to get new health plans like the members of Congress once health reform passed.

That did ring a bell with us, so we searched Obama's stump speeches, and found his specific remarks.

"If you don't have insurance, or don't like your insurance, you'll be able to choose from the same type of quality private plans as every federal employee -- from a postal worker here in Colorado to a congressman in Washington," Obama said in Newport News, Va., on Oct. 4, 2008. "All of these plans will cover essential medical services including prevention, maternity, disease management and mental health care. No one will be turned away because of a pre-existing condition or illness."

President Obama made similar remarks several times, describing a new national health care exchange by describing the way federal employees pick health plans. Because the federal work force is so large, many insurers are willing to offer them plans, and employees can select from very basic options with high deductibles to more expensive, comprehensive coverage. The system covers more than 9 million employees, retirees, former employees, family members and former spouses, according to the Office of Personnel Management's Web site.

The comparison to Congress seems to be a way of describing the concept of the health insurance exchange, which is part of Democratic plans for health reform currently under consideration.

But it's Obama's comments that people would have access to the exchange if you "don't like your insurance" that aren't addressed by the Democrats' health care plan. That clearly implies that anyone unhappy with their current coverage could go into the exchange, and that is not the case under the current proposals for reform.

Bills in the House and the Senate would limit the exchanges to individuals and small businesses. If your employer offers a policy, you would not be able to reject that insurance and enter the exchange.

In fact, Sen. Ron Wyden, D-Ore., has been promoting an amendment that would open the exchange to people who get insurance from a large employer.

"Under the nation's current employer-based system, most people have little if any choice about where they get their insurance," Wyden wrote in an op-ed in the New York Times . "They just have to accept the plan that comes with their job. That insurance company, in turn, is provided a captive group of customers, so it has no incentive to earn their loyalty."

But right now, it doesn't look as if his amendment will be part of the final plan.

So we're adding Obama's promise about people being able to use the exchange to buy insurance "if you don't have insurance, or don't like the insurance." Because the bills under consideration don't open the exchange to people who want another option, we're rating the promise Stalled.

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