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Under the Patient Protection and Affordable Care Act (PPACA), states will be required to operate health insurance exchanges – marketplaces where individuals and small businesses can purchase private health insurance – beginning in 2014. Over the last several months, ABC has provided suggestions on how the exchanges can best be implemented.

On Sept. 24, ABC, as a member of the Choice and Competition Coalition, wrote to the chairman of the D.C. Health Benefit Exchange Authority Executive Board and expressed concern about “reports that the District of Columbia is poised to issue regulations governing their health exchange that could close off, or eliminate the ability of small businesses and individuals to purchase health insurance in the outside market.” The coalition further stated, “We believe this proposed regulation is ill advised and would dramatically reduce consumer choice.”

In the letter, the coalition offered the following recommendations to the executive board:

  • Preserve the ability of individuals and small businesses to purchase health insurance in the outside market. If the D.C. health insurance exchange eliminates the outside market and limits the plans that could offer health insurance coverage through the newly created exchange, choices would be severely curtailed. The coalition recommended against any extreme measures to eliminate the outside market.

  • Do not increase costs for small employers. The coalition noted that the D.C. Insurance Subcommittee’s recommendations would unnecessarily lead to increased cost for employers. The subcommittee is supporting an exchange as the sole marketplace because it will “eliminate the opportunity for adverse selection against the exchange.” However, the letter noted that PPACA includes numerous provisions to create a level playing field inside and outside an exchange that do not require elimination of the outside health insurance market.

  • Continue to define the small group market as those with 50 or fewer employees. With all the changes that will take place in 2014, including major insurance market reforms and the creation of new health insurance exchanges, it makes little sense to expand the small group market beyond the traditional definition of 50, the letter noted. The coalition called for this change to be held off until the statute requires it in 2016.

The Choice and Competition Coalition is a partnership of businesses, providers, brokers, and insurers working to ensure that health insurance exchanges created under PPACA promote competition and preserve consumer choice. For more information on the coalition, visit

For more information about exchanges, read the March 14 Newsline article on the final rule or the May 23 article that includes links to Health and Human Services guidance on the rule.