Organizations & Policy Objectives Bruce Rhodeback-2
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Franklin University *
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Jan 9, 2024
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Organizations & Policy Objectives 1
Organizations & Policy Objectives
Bruce Rhodeback
HCM 752: Health Policy
Franklin University
Dr. Monica Taylor
Organizations & Policy Objectives 2
Abstract: This paper explores the process of implementing the Health Insurance Marketplace segment of the Affordable Care Act (ACA) by the U.S. Department of Health and Human Services (HHS). It delves into the roles and responsibilities of the Centers for Medicare & Medicaid Services (CMS) and the Center for Consumer Information and Insurance Oversight (CCIIO) in ensuring equitable, quality, and affordable healthcare access for all Americans. The paper also highlights the extensive experience and expertise of CMS in healthcare programs and its pivotal role in ACA implementation.
Introduction
Once a health policy has been enacted through the enactment of legislation, the next step in the policymaking process involves the implementation of that policy by the executive branch through the promulgation of rules and regulations and their actual implementation by the executive branch. In the instance of the Health Insurance Marketplace (Healthcare.gov), a section of the Affordable Care Act (ACA) was implemented on October 1, 2013, by the Health Insurance Marketplace (HHS, n.d.). This assignment explores the process of accessing the Affordable Care Act's health insurance marketplace through the U.S. Department of Health and Human Services (HHS), in addition to the roles and responsibilities of the agencies responsible for implementing the provisions of the Affordable Care Act and their respective competencies.
The Path to the Health Insurance Marketplaces Segment of the Affordable Care Act
Determining which entity is responsible for implementing the Health Insurance Marketplaces segment of the Affordable Care Act within the U.S. government is a challenging task. The exploration begins with the Department of Health and Human Services (HHS, n.d.). Initially, the main website of the Department of Health and Human Services (HHS) is explored.
Organizations & Policy Objectives 3
The "Programs and Services" section of the website (
https://www.hhs.gov/programs/index.html
) provides information regarding "Health Insurance Options" (
https://www.hhs.gov/programs/health-insurance/index.html
). Within this section, the healthcare insurance marketplace option is located, and the link to Healthcare.gov (
https://www.healthcare.gov/
) is followed. While the Healthcare.gov website offers various resources related to enrolling in, canceling, and changing health insurance plans, the focus is on the "Resources" section at the bottom of the page, which is expected to provide the necessary information. By selecting "Regulatory and Policy Information" within the "Resources" section, the website of the "Center for Medicare and Medicaid Services" (CMS) (CMS.gov, n.d.) is accessed. The introductory page of CMS confirms that the agency is responsible for overseeing the implementation of provisions related to private health insurance, particularly the establishment of new health insurance marketplaces in collaboration with states.
Liabilities and Mission of CMS and CCIIO
A federal agency within the Department of Health and Human Services (DHHS) known as the "Centers for Medicare & Medicaid Services (CMS)" administers the Medicare program in addition to its collaboration with states to support Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards. Through surveys and certification procedures, CMS is responsible for maintaining nursing home quality standards, ensuring compliance with HIPAA administrative simplification requirements, offering Medicare Advantage Plans in Spanish, maintaining clinical laboratory quality standards, managing Medicare and home-related services, and overseeing HealthCare.gov. Also, the organization facilitates the acquisition of health insurance plans by selling CMS-1500 forms, the official standard Medicare and Medicaid health insurance claim form, available at U.S. government
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Organizations & Policy Objectives 4
bookstores. An integral part of CMS' mission is the advancement and integration of health equity
into the design, evaluation, and implementation of policies, programs, and partnerships (AMA, n.d.).
Located within the Department of Health & Human Services (DHHS), the "Center for Consumer Information and Insurance Oversight (CCIIO)" division of CMS assumes national leadership in establishing and enforcing standards for health insurance that promote equitable and reasonable practices, ensuring all Americans are able to access high-quality, affordable healthcare (
https://www.cms.gov/cciio
). Additionally, the CCIIO provides consumers with comprehensive information regarding various coverage options to assist them in making informed decisions regarding their health insurance coverage. To ensure that the Affordable Care
Act serves the American people effectively, the agency collaborates closely with state regulators,
consumers, and other stakeholders (CMS.gov, n.d.).
CMS's Favor Of Implementing ACA
Due to its extensive experience in healthcare programs dating back to 1965, CMS emerged as a suitable entity to implement the Affordable Care Act. This agency has a strong foundation and extensive expertise in health policy that extends far beyond the regulatory framework. In addition to its expansive infrastructure and abundant resources, CMS fulfills the needs of various stakeholders at the state level, making it an integral part of the implementation of the Affordable Care Act (AMA, n.d.).
Conclusion
In summary, when it comes to the implementation of the Affordable Care Act's health insurance marketplace, CMS and CCIIO play crucial roles in ensuring that healthcare access for
Organizations & Policy Objectives 5
all Americans is equitable, quality, and affordable through their diverse responsibilities and functions (CMS.gov, n.d.).
Organizations & Policy Objectives 6
References
AMA, n.d., American Medical Association, Health Insurance Marketplace Reform,
https://www.ama-assn.org/
CMS.gov. (n.d.). Consumer Information and Insurance Oversight. CMS.gov Centers for
Medicare and Medicaid Services. https://www.cms.gov/CCIIO
HHS. (n.d.). U.S. Department of Health and Human Services. https://www.hhs.gov/
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