Each state creates one or more regional alliances that organize a menu of health plans, negotiate premiums and enroll individuals in plans. Within broad federal parameters, states exercise flexibility in the design and governance of regional alliances. The vast majority of people continue to choose their health care coverage through their employers, who provide information on area health plans available through the alliance. Retirees not yet eligible for Medicare Individuals who are not employed. Alliances organize and streamline the fragmented insurance system, replacing health insurance brokers, agents and underwriters with consumer-run organizations focused on providing access, service, quality and affordable care.
Alliances drive the competitive forces that make the new system work for consumers and employers.
Negotiate premiums and coverage and ensure the delivery of high-quality care while controlling costs. Assure that all residents in the area enroll in health plans that provide the guaranteed comprehensive benefits. Where inadequate services exist, alliances may organize health providers or use financial incentives to encourage health plans to expand. Alliances operate as non-profit corporations, independent state agencies or agencies of the executive branch of the state. The board of each alliance includes an even number of consumer and employer representatives but may not include health providers and others who profit from the industry.