Sec. 104. State options for improved access to health insurance coverage in each State
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/bill/114/hr/2756/ih/section-104·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Each State may carry out any of the functions described in succeeding subsections in order to improve the access of residents of the State to health insurance coverage. A State may use or adapt an Exchange that the State has established under title I of PPACA to carry out the any of such functions. The Federal Government shall make available to States current capabilities of the Federal Exchange, including the Federal Data Services Hub and Agent Broker Portal, to the extent requested by a State for activities related to enrollment of citizens of the State into health insurance coverage.
Each State may establish and operate an open and transparent marketplace mechanism whereby qualified residents of the State can readily compare, through the use of the Internet, the benefits and prices between different health insurance coverage options made available to them. Subject to paragraph (2), a State may provide for the enrollment of qualified residents of the State who are uninsured in default health insurance coverage offered under section 105(c) and establishing an HSA for such residents who do not have an HSA unless the resident has affirmatively elected not to be so enrolled and not to have an HSA, respectively.
Any such enrollment under this paragraph shall be coordinated with the annual open enrollment periods provided under section 105(b). As a condition of a State providing for the enrollment function described in paragraph (1), the State must establish an easy-to-use and transparent means by which individuals may elect not to be enrolled in default health insurance coverage or to have an HSA established on the individual’s behalf, or both. Notwithstanding any other provision of this title or section 223(c)(2) of the Internal Revenue Code of 1986, a State may establish— mechanisms for risk mitigation or risk adjustment in order to limit volatility in the premiums based on health experience to class-average premiums; and a reinsurance and risk-corridor program that involves no Federal funds with respect to coverage both in the individual market and in the small group market.
Mechanisms and programs under paragraph
(1)may be based on the health status score of each individual enrolled in health insurance coverage in the individual market and not solely based on the aggregate risk of the risk pool with respect to each plan of health insurance coverage.