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Archive for March, 2014

Eight Senate measures amend, build on ACA insurance reforms

March 31st, 2014 Comments off

Democratic senators have new ideas for health care law | Washington Watch | McClatchy DC.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Individual market could turn into SHOP’s biggest competitor

March 27th, 2014 Comments off

In a post last December, I characterized small group as the most voluntary – and consequently the most vulnerable – health insurance market segment notwithstanding Patient Protection and Affordable Care Act reforms designed to improve it. Whether these reforms will ultimately help shore up this distressed market segment remains to be seen, I wrote at the time.

A key ACA reform to create market power on the buy side to help drive down rising premiums – small employers identify high premiums as the biggest barrier to covering their employees – is the mandate each state health benefit exchange establish a voluntary small employer purchasing pool known as the Small Business Health Options Program (SHOP). However, experts have recently suggested that in the eyes of potential small employer SHOP enrollees, SHOP’s biggest competition could come from the individual marketplace as they cease providing employer-sponsored coverage.

Ezekiel J. Emanuel, who helped draft the Affordable Care Act as a health policy adviser to the Obama administration, had this to say to The New York Times small business blog You’re the Boss:

I’ve always been a bit perplexed by the idea of setting up a SHOP exchange, since I don’t understand why it’s just not better if you’re a small business to say, all right, everyone, I’m just going to give you X amount of dollars and let you shop in the individual market. That seems to me to be a way to go – why should a small business set up a lot of machinery around it? Why should exchanges set up a lot of machinery? And it would be better for exchanges to have these workers in the individual exchange.

As small employers who early renewed plan year 2013 plans late last year migrate to ACA-compliant plan year 2015 plans, a quarter of small group plan members could end up moving to individual coverage from November 2014 through January 2015, estimates health insurance industry veteran and consultant Michael Lujan. Lujan is former SHOP director at California’s exchange, Covered California.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

California exchange seeks alternative options for online individual market

March 19th, 2014 Comments off

Covered California, California’s state-operated health benefit exchange marketplace, is seeking information on alternative options for its individual market web portal to determine potential benefits relative to increased enrollment, feasibility and costs.

The exchange issued a Request for Information (RFI) on March 18 seeking information relative to an “online consumer-facing retail agent” or a platform enabling independent agents to offer online quotes for individual coverage. Last month, Covered California delayed until fall 2014 the launch of the web portal for small group coverage sold through its Small Business Health Options Program (SHOP).

Responses to the RFI are due March 28.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Gruber warns of increased tendency toward cost shifting between health and workers’ compensation systems

March 13th, 2014 Comments off

The trend toward less generous employer-sponsored health coverage and increased employee cost sharing has increased the exposure of the workers’ compensation system to cost shifting, warns Jonathan Gruber. Gruber was the architect of the Massachusetts Health Connector a decade ago that served as the template for the health benefit exchange and individual and small group market reforms of the Patient Protection and Affordable Care Act. Cost shifting between the two systems occurs when, for example, an employee who sustains an injury or illness over the weekend and then files a workers’ compensation claim on Monday, asserting that the injury or illness originates in the workplace.

Heightening the tendency toward cost shifting is the difference in provider access between health and workers’ compensation insurance, Gruber notes, arguing that the two forms of coverage require greater harmonization. “If the workers’ compensation system stays behind, it will have the broadest possible network and the lowest possible cost-sharing, and it’s going to have people migrating into it more and more,” Gruber said in remarks to the Workers Compensation Research Institute (WCRI) in Boston reported by the Insurance Journal.

In 2007, then-California Gov. Arnold Schwarzenegger proposed as part of his health care overhaul (based on Gruber’s Massachusetts’s model) a “24-Hour coverage” pilot program that would have combined the medical treatment component of workers’ compensation with group health coverage. State and local government employees would obtain medical care through the same providers used in a state run managed care program for work and non-work-related health care, with an option for private employers to participate on a limited basis.

According to a report prepared that year by the California Commission on Health and Safety and Workers’ Compensation, at least 10 states adopted legislation permitting 24-hour care pilots but only two — Oregon and California – implemented them. Merging medical treatment coverage for care needs arising out either vocational or non-vocational circumstances can potentially reduce frictional costs and achieve administrative efficiencies, but has proven problematic due to various legal, institutional and cultural impediments.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Concerns over large group plan exchange option overblown

March 5th, 2014 Comments off

Concern is being raised that a Patient Protection and Affordable Care Act provision allowing large group plans (defined as those offered to employers of 101 or more beginning in 2017) to offer plans on state health benefit exchanges could disrupt the large group market. The basis of the concern is an ACA requirement at Public Health Service Act Section 2701(a)(5). The section would apply the ACA’s mandate on individual and small group plans, requiring they use modified community-based rating (rather than risk rating) to large group plans in those states that elect to allow large group plans to be sold via their health benefit exchange marketplace:

(5) SPECIAL RULE FOR LARGE GROUP MARKET.—As revised by section 10103(a). If a State permits health insurance issuers that offer coverage in the large group market in the State to offer such coverage through the State Exchange (as provided for under section 1312(f)(2)(B) of the Patient Protection and Affordable Care Act), the provisions of this subsection shall apply to all coverage offered in such market (other than self-insured group health plans offered in such market) in the State.

My impression is this concern is overblown. It’s both unlikely that states will be interested in bringing large group plans into their exchange marketplace or that large group plans would want to participate. The Affordable Care Act’s enhanced risk spreading mechanisms contained in market rules and the exchange marketplace needed in the individual and small group markets are less necessary for large group plans that already benefit from greater scale and spread of risk. In addition, a robust private exchange marketplace is springing up to offer large employers more opportunity to create even larger pools and greater spread of risk.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Federal government expands ACA transitional relief for individual, small group plans

March 5th, 2014 Comments off

The U.S. Department of Health and Human Services issued guidance today affording states and health plan issuers more time to optionally keep in place health plans not compliant with Patient Protection and Affordable Care Act requirements relating to minimum benefit levels, modified community based rating and guaranteed issue to all applicants without medical underwriting.

The Center for Consumer Information and Insurance Oversight’s extended transitional policy provides transitional relief from these requirements for plans issued through October 1, 2016 as well as the ACA’s requirement that health plan issuers use single statewide risk pools for the individual and small group markets, respectively.

The newly issued guidance follows on similar guidance issued to state insurance commissioners in November 2013 that gave states the option of relieving individual and small group plans from these ACA provisions through September 2015. That guidance was issued in response to a consumer uproar when health plans issued cancellation notices for non-ACA compliant health plans — many of them falling into a time gap between grandfathered plans that were in place when the ACA was enacted in March 2010 and January 1, 2014 when all individual and small group plans must be ACA compliant. President Obama complained the ACA grandfather clause proved “insufficient” in allowing for this gap.

Today’s guidance also extends guidance issued December 19, 2013 permitting individuals whose non-ACA compliant policies were cancelled to qualify for a hardship exemption from the requirement all individuals have health coverage. That exemption allows them to purchase catastrophic coverage and is being extended to October 1, 2016.

Under today’s guidance, states may choose to adopt both the November 2013 transitional policy and the extended transitional policy through October 1, 2016, or adopt one but not the other. States also have the option to apply the relief to both the individual and the small group markets or just one market. Additionally, states can opt to apply the transitional relief solely to large employers if they choose to define the small group market as being employers of 100 or fewer employees for policy years beginning on or after January 1, 2016 as authorized by the ACA.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Long waits frustrate callers to health exchanges | The Detroit News

March 1st, 2014 Comments off

Long waits frustrate callers to health exchanges | The Detroit News.

The take away from this account is expectations about how people do business with the health benefit exchange marketplace need some adjusting. While some people are comfortable purchasing health insurance online, many others are not. As California’s experience shows, lots of folks are using the web portal for that state’s marketplace, Covered California, to “showroom” plans — to browse what’s available and on what terms and conditions. They then call the customer service center to get more details before making a purchasing decision, overwhelming staff also pressed to respond to consumers having trouble enrolling online.

But enrolling in health insurance over the phone isn’t easy and quick either, particularly given that the transaction in the exchange marketplace involves an eligibility process to determine if an applicant qualifies for Medicaid or premium and co-pay subsidies. Adding to the enrollment challenge is many households having complex family situations.

Marketplace plan enrollment is proving for many more akin to preparing and filing an income tax return, particularly considering the amount of personal and financial information applicants must provide.

With the benefit of hindsight now that the plan year 2014 open enrollment period is nearly over, it’s clear that instead of heavily relying on web and phone enrollment, the marketplace needs to adjust to one more based on in-person enrollment using assisters, county social service workers and insurance agents.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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