Vol. 24 Annals of Health Law 361
and compare private insurance plans.185 The Marketplaces, in addition to
running a private insurance market, are making important determinations
for individuals seeking health insurance. The Marketplaces will determine
who is eligible to obtain coverage on the Marketplaces and who is ineligible
because they have affordable coverage through their employer.186 Second,
among individuals eligible for insurance coverage, the Marketplaces are
administering a public-benefit-like program. The Marketplaces administer
premium tax credits and cost-sharing subsidies to make private health insurance more affordable.187 These tax credits are essentially a redistribution
program administered through the tax code – much like the Earned Income
Second, the Marketplaces in many states will actually make Medicaid eligibility determinations.189 Marketplaces are intended to operate as a one-stop shop for health insurance coverage.190 Individuals who do not know
whether they are eligible for Marketplace-based or Medicaid coverage can
fill out an application on the Marketplace website and will be directed to
the proper insurance.191 This means that the Marketplaces are, at a minimum, making initial assessments of Medicaid eligibility.192 Some states
have even fully delegated Medicaid eligibility determinations to the Marketplaces, as permitted by federal regulations.193 As of November 2014,
over 6.7 million people had been assessed or determined eligible for Medicaid by their Marketplace.194
185. Applicants can also submit their applications in person and by phone. Ctrs. for
Medicare & Medicaid Servs, How to Apply & Enroll, https://www.healthcare.gov/apply-and-enroll/how-to-apply/ (last visited Oct. 17, 2014) (noting that applicants can also submit
their applications in person and by phone).
186. See 42 U.S. C. A. § 18081(a) (West, WestlawNext through P.L. 113-174).
187. See id. § 18082.
188. See id. § 18082(c) (noting that the Secretary of HHS notifies the Treasury that an
individual is eligible for advance premium tax credits). See generally Lawrence Zelenak,
Tax or Welfare? The Administration of the Earned Income Tax Credit, 52 UCLA L. Rev.
1867, 1873 (2005) (describing the EITC as a hybrid between a welfare program and tax benefit where the IRS provides subsidies to low-income families through the tax system).
189. SARAHDASH ET AL., IMPLEMENTING THEAFFORDABLECAREACT:KEYDESIGN
DECISIONS FOR STATE-BASED EXCHANGES, COMMONWEALTH FUND 10 (2013), available at
191. See id. at 10–11 (noting how states rely on “communication between the exchange
and other state eligibility engines –such as the databases that determine if individuals are
eligible for programs like Medicaid”).
192. See id.
193. See id.
194. Kaiser Family Found., State Marketplace Statistics (2014), http://kff.org/health-
reform/state-indicator/state-marketplace-statistics-2/ (last visited Nov. 1, 2014) (data is updated each year).