HB518 Alabama 2023 Session

Summary

Primary Sponsor

Reed IngramRepresentative

Republican

Session

Regular Session 2023

Title

Regarding health insurance; to provide for a state health care exchange pursuant to the federal Affordable Care Act; to establish a governing board of directors and an executive director and require the board to operate the exchange; and to provide for coordination with and assistance from the Department of Insurance. B

Summary

HB518 would create the Alabama Health Insurance Exchange, a nonprofit marketplace to help residents buy ACA-compliant health plans, overseen by a new board and executive director with coordination from the Department of Insurance.

What This Bill Does

It establishes a state health insurance exchange to facilitate the purchase and sale of qualified health plans in Alabama’s individual market and SHOP. The exchange will be governed by a Board of Directors and an Executive Director, operate under specific governance rules, and be responsible for planning, budgeting, reporting, and ensuring compliance with applicable laws. It also enables coordination with the Department of Insurance and other state agencies and authorizes pursuing a Section 1332 innovation waiver if approved.

Who It Affects

• Alabama residents seeking health insurance: gain access to an ACA-based exchange, education, and help with subsidies and enrollment.
• Health insurers and brokers: may offer qualified health plans through the exchange and interact with the exchange for certification and enrollment.
• Employers and small businesses: access to SHOP and plan options through the exchange.
• State agencies and government entities: the exchange coordinates with the Department of Insurance, Medicaid Agency, and Department of Public Health, with reporting to the Governor and Legislature.
• Taxpayers and the public: the exchange is exempt from state taxes and operates with public reporting and transparency requirements.

Key Provisions

• Creates a nonprofit Alabama Health Insurance Exchange to provide access to qualified health plans and to certify plans for purchase through the exchange.
• Establishes a Board of Directors (appointments by Governor, Lt. Governor, Senate President Pro Tempore, and Speaker of the House, plus the Commissioner, State Health Officer, and Medicaid Commissioner) with terms and diversity requirements; the Commissioner serves as chair; an executive director is hired to run the exchange.
• The exchange is not a state agency and is exempt from state taxes, competitive bidding laws, the state Merit System, and the Alabama Administrative Procedure Act; it must not duplicate or impair the powers of the Commissioner.
• The Board must create a preliminary and final plan of operation, hire staff, adopt bylaws, maintain financial records, conduct annual audits, and provide annual fiscal and operational reports to the Governor and Legislature.
• The exchange will educate consumers, run a navigator program, assist with income-based assistance (premium tax credits and cost-sharing reductions), and enable enrollment directly with carriers, web brokers, or licensed agents.
• Requires compliance with HIPAA and related privacy laws; allows sharing de-identified data for program administration; coordination with federal and state agencies as needed.
• Authorizes pursuing a Section 1332 innovation waiver, with joint recommendations due by January 1, 2025, and potential submission and implementation if approved by the Governor and federal agencies.

AI-generated summary using openai/gpt-5-nano on Feb 22, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Affordable Care Act, establish state-based health insurance exchange