More About Dave Chandra

Dave Chandra

Dave Chandra is a Senior Policy Analyst at the Center on Budget and Policy Priorities in the Health Policy Department.

Full bio and recent public appearances | Research archive at

CBPP Releases New Resource on State Marketplace Design and Policies

April 17, 2014 at 11:28 am

Health reform’s marketplaces launched in every state on January 1, offering individuals and small businesses the opportunity to shop from an array of affordable, comprehensive health insurance plans.  Now that the open enrollment for 2014 coverage has closed, states have a chance to fine-tune their plans for next year.  A new database that CBPP has launched will give them critical information that they’ll need to make those decisions.

The health reform law gave states the option to establish and operate their own marketplace as a State-based Marketplace (SBM), partner with the federal government through a State Partnership Marketplace (SPM), or defer to the federal government to provide a Federally-facilitated Marketplace (FFM) in the state (see map).

The states that opted to develop their own marketplaces or to partner with the federal government have significant design and operational flexibility to exceed federal minimum requirements and tailor the program to meet state-specific needs.

CBPP has analyzed the 17 SBM and 6 SPM states across a number of design questions as well as best practices.  We’ve summarized the findings in a new database that states can use as they work to ensure that their marketplaces meet adequate competition, affordability, accessibility, and customer satisfaction requirements.

Among our key findings:

  • Marketplace governance:  In an effort to ensure independence in governance and policy setting, avoid conflicts of interest, and ensure long-term viability, 11 states created a quasi-governmental agency to operate their marketplaces.  Governing boards composed of experts and key stakeholders oversee the new agencies; the majority of states prohibit insurers and/or brokers from serving on the board.
  • Marketplace plan standards:  States adopted a variety of innovative standards to enhance competition and affordability, improve value and transparency for consumers, and mitigate the risk of “adverse selection,” under which sicker-than-average people buy marketplace insurance compared with those who enroll outside the marketplaces, which would result in higher marketplace premiums.  In fact, several require that issuers offer a standardized plan design to enable consumers to more easily compare plans based on price and provider networks.
  • Customer service and website features:  States used a variety of interactive web features to provide a customer-friendly application and shopping experience, including allowing consumers to browse plans before creating an online account or submitting an application.  Many states also allow consumers to effectively filter and search marketplace results by plan features, including by premium, deducible, co-pays, or provider.

CBPP will continue to collect and update information on each State-based Marketplace and State Partnership Marketplace, and we’ll provide additional analysis to assist states as they institute marketplace policies for the 2015 plan year and beyond.

Click here to access the interactive database.

Good News For Health Insurance Consumers in the District of Columbia

June 10, 2013 at 3:00 pm

The D.C. Council has taken a big step forward in implementing health reform.  The legislation that it unanimously approved last week will greatly enhance competition, transparency, and the affordability of health insurance for individuals and small businesses in the District.

The legislation — the Better Prices, Better Quality, Better Choices for Health Coverage Emergency Amendment Act of 2013 — sets forth key standards for health plans that insurers want to sell in the D.C. Exchange (i.e., or health insurance marketplace), providing significant consumer protections and value to District residents.  In addition, the bill transitions the current individual and small group insurance markets into a single unified market that the D.C. Exchange will oversee.

A diverse coalition of consumer groups, patient advocates, health care providers, small businesses and others, including the Center and our partner organization, the D.C. Fiscal Policy Institute, supported the D.C. bill.

The District joins Vermont as the only two jurisdictions with state-run unified health insurance marketplaces.  That’s especially important for smaller states where fragmentation in the markets can lead to less transparency, higher premiums, and greater difficulty for regulatory oversight and enforcing consumer protections.  A unified market will benefit D.C. consumers because it:

  • ensures meaningful standards that apply to all health plans in the individual and small group market, including robust definitions for coverage of mental health treatment, services for autism, and prescription drugs;
  • increases transparency, since all health plans in the market will be displayed in an easy-to-use online portal, through which consumers can make apples-to-apples comparisons of plans as they shop;
  • fosters greater competition among insurers, as each insurer must display all of their plans and premiums side-by-side with their competitors and compete based on price and quality; and
  • limits the risk of adverse selection by preventing insurers operating outside the exchange from “cherry picking” the healthy, which could threaten the long-term viability of the exchange.

D.C. Council approved the bill on an emergency basis to expedite its provisions, but the Council must consider a permanent version in the coming months.  The final bill must include these critical consumer standards if the District wishes to meet its commitment to provide access to affordable health care for all D.C. residents.

Exchanges Will Offer Consumers Better Choices in Every State

February 21, 2013 at 4:40 pm

Every state has now decided whether, under health reform, it will build and operate a state-run “exchange” — a marketplace where individuals and small businesses can compare and purchase insurance coverage — partner on an exchange with the federal government, or have the federal government operate an exchange in the state.

Seventeen states and Washington D.C. will go for a state-run exchange, seven states say they’ll pursue a State Partnership Exchange with the federal Department of Health and Human Services, and the remaining 26 states will let the federal government run an exchange within their borders (see map).  Moving forward, however, states that opt for a federally facilitated exchange or a partnership today can transition to a fully state-run exchange in coming years.

While health care aficionados have tracked the states’ decisions closely, we shouldn’t forget that residents in all states will benefit from major improvements to the way insurance is designed and sold, regardless of whether their state runs its own exchange or has the federal government operate one.  Most people without access to insurance today will be able to use these exchanges to comparison shop among a number of affordable, comprehensive coverage options.  And, depending on their income, many will receive tax credits to help cover the cost of this coverage as well as assistance with co-pays and deductibles.  Small businesses also can buy from these new marketplaces, offering many more choices to their employees than are available today.

People who are now covered will see upgrades to their insurance.  Often, many small businesses and individuals who buy insurance today can only afford policies that skimp on coverage or place lots of financial barriers on accessing care, especially for people who are sick.  In 2014, new insurance market rules will prevent insurance companies from selling products that discriminate against older people, women, and people with pre-existing health conditions.  Health reform (i.e., the Affordable Care Act or ACA) also creates standards to ensure that insurance policies provide value to consumers by covering the kinds of benefits and services most people need and limiting what they have to pay out of pocket for deductibles and co-pays.

There’s lots of work left to ensure that consumers can take advantage of all of the ACA’s benefits that start next year.  But residents in all states, regardless of whether their state will run its own exchange, will gain an insurance marketplace that is far more fair, transparent, and value-driven than today.

No More Reason to Delay Health Insurance Exchanges

November 8, 2012 at 4:55 pm

For months, many state leaders who oppose health reform have delayed implementing the parts of the law that fall under state purview — most notably, planning the new “exchanges” (or marketplaces) that will allow families and small businesses to shop for affordable health plans.  Now that this week’s election results suggest that health reform is here to stay, states that have dragged their feet need to get to work.

Several states have made significant progress towards launching their exchanges by the October 1, 2013 start of open enrollment.  Many others have held back, as we’ve tracked here.  But it’s not too late for a state to act.

States have three options:

  • build a state-based exchange;
  • let the Department of Health and Human Services (HHS) design and operate an exchange in the state; or
  • enter a partnership agreement with HHS in which HHS designs the exchange but the state helps operate it.

States must submit their proposal for HHS approval by November 16.  While that probably precludes a lot of states from developing a state-based exchange for 2014, they can still consider creating one in 2015 after having a federal exchange in the state for a year.  They also have time to refine plans to pursue the partnership option, in which the state oversees critical functions like health plan management and consumer outreach.

States that want to operate an exchange face a lot of decisions and tasks between now and when it must launch in October 2013.  They need to build a user-friendly application process, determine which health insurance plans will be sold, organize outreach and education plans, and set up a call center and programs for in-person assistance to consumers.

Consumer groups in the states have been making recommendations in these areas, and leading states have designed policies that could serve as examples to latecomers.  HHS has repeatedly said that it will help any state interested in building an exchange.  But it’s up to each state to decide whether it wants to have any role in establishing its exchange.

Five Reasons Why States Should Act Quickly to Set Up Health Insurance Exchanges

July 5, 2012 at 9:51 am

Now that the Supreme Court has upheld the Affordable Care Act, we know that insurers will no longer be able to deny people coverage or charge them more based on their health status or gender, subsidies will be available to help people with low and moderate incomes afford coverage, and a state or federal exchange will be operating in every state in 2014.

A number of states are well on their way to establishing their own exchanges.  But many other states instead have dragged their feet, citing uncertainty prior to the high court’s ruling (see map).  With last Thursday’s decision, however, states can no longer use that excuse as grounds to avoid implementing the law.  States that have said they prefer to operate their own insurance exchanges (rather than have the federal government run the exchanges for them) must act quickly.

Five reasons why states should start or resume planning activities immediately:

1. Deadlines are approaching – quickly. States must officially notify the Department of Health and Human Services (HHS) by November 16, 2012 – that is, in less than five months – of their intention to operate a state-based exchange and submit an application for federal approval of the exchange’s design and operations.

2. Applications alone won’t be enough. States seeking approval of their exchange proposal have to demonstrate sufficient progress to HHS by January 1, 2013 in order to prove that their state does not need a federally run exchange.

3. Operations will start before 2014. Exchanges – whether state- or federally run – will have to start enrolling individuals, families, and small businesses by October 1, 2013.  States operating an exchange will also need to ensure they can determine eligibility for federal premium and cost-sharing subsidies available to individuals with low and moderate incomes who will buy coverage through the exchange.  They also must be able to coordinate with their state Medicaid and CHIP programs.  This means that new and improved information technology systems must be developed and tested.

4. Key policy decisions will take time.  States must decide how they’ll approach and implement a wide variety of policies, such as financing operations of the exchange after 2014, selecting health plans to be sold in the exchange, conducting outreach and education to consumers, and developing services to attract small businesses.

5. Federal grant funds are available to fully fund states’ exchange set-up costs. States can apply for and receive federal funds that will finance all costs related to the design and launch of their exchanges.  The funds can be used to conduct research on their insurance market, develop or upgrade their IT systems, hire and train staff, as well as support all operating costs for the exchange’s first year.  The grants will be provided through 2014, as long as funds are available.  But the sooner states access the funds, the sooner they can put them to work – and increase their chances of meeting all of the important implementation deadlines.

Despite these factors, leaders in several states responded to the Supreme Court decision by continuing to delay their own decisions on whether to move forward and create a state-based exchange.  Because of the time crunch, this foot-dragging could effectively be a decision in itself – to forgo any chance of operating an exchange themselves and instead default to an exchange set up by the federal government.