The Patient Protection and Affordable Care Act (ACA) calls for states to have fully operational health insurance exchanges by 2014, and Milliman is uniquely positioned to help states successfully implement an exchange or multiple exchanges. We offer sophisticated tools for analyzing the implications of healthcare reform and modeling risk adjustment; our scenario simulation tool helps states understand the enrollment and premium shifts that may occur due to implementation of exchanges and other changes to the health insurance marketplace. Our comprehensive exchange-related services also include IT and operations expertise. We help states understand the enrollment and premium shifts that may occur due to implementation of exchanges and other changes to the health insurance marketplace and determine the personnel, systems, and processes required to implement and operate an ACA compliant exchange.

The Patient Protection and Affordable Care Act (ACA) will introduce new marketplaces for individual and small group health insurance in the form of public exchanges. Health insurance plans need to fully prepare for and understand the impact that the public exchanges may have on their business. The logjam that blocked reform progress for several months appears to have been cleared; ACA is now moving forward with weekly releases of regulations and rules. This momentum of rule writing brings new terminology and issues to light, which are critical to understand before making decisions on whether or not to participate in the public exchanges. This paper provides 10 critical considerations based on the preliminary rule recommendations published in the last half of November. As these rules are finalized, the considerations and market dynamics may change.