United States

The Market Model for Sustainable ACA State Exchanges

Jan 27, 2014
From the Government Institute

The Patient Protection and Affordable Care Act of 2010 (ACA) provided certain federal grant funding to help establish and support implementation and initial operation of State-Based Exchanges (SBEs).The source of funding for SBE operations after initial implementation is of significant concern for many states and issuers. Implementing the right financial model will be critical to the long-term sustainability of the SBE and to healthcare insurance for their customers.

As the SBEs represent a significant change to the traditional health insurance marketplace, finances should be monitored diligently by states to help ensure that overall cost of insurance remains affordable within the marketplace and aligns with ACA objectives.

This KPMG Government Institute Issue Brief, developed in conjunction with KPMG’s Global Human & Social Services Center of Excellence, summarizes the federal regulations relating to ACA financial sustainability and identifies potential SBE financial sustainability operating models.