State RegulationsTX specificDifficulty 1/5
Under the exchange provision of the federal health care reform law, what happens when a state such as Texas does not establish its own health benefit exchange?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under ACA Section 1321, where a state does not establish its own exchange, the exchange is operated by the U.S. Department of Health and Human Services, which is why Texas residents enroll through the federally-facilitated marketplace rather than through a state-run exchange. That election has no effect on the rest of the framework: financial assistance remains available, insurers licensed by the Texas Department of Insurance may still offer qualified health plans through the marketplace, and the state's Medicaid program is untouched.
Why the other options are wrong
- B) Residents do not lose financial assistance because their state declined to run an exchange; assistance remains available through the federally-facilitated marketplace.
- C) Licensed insurers are not barred from the marketplace; they may offer qualified health plans there.
- D) The Medicaid program is a separate program and is not terminated by a state's decision not to establish an exchange.
Memory hook
No state exchange in Texas means the federal marketplace runs it.