Monthly Archive: April 2015

ACA Section 1332 state innovation waiver analyzed as political pressure relief valve

I’ve previously written about a little noticed Patient Protection and Affordable Care Act provision at Section 1332 of the law that could have major implications for how states implement the law. It’s now getting notice from a major think tank, the Brookings Institution, which analyzes the Section 1332 state innovation waiver provision as a political pressure relief valve for gridlocked Washington and for states that continue to have difficulty accepting the law’s prescriptions for reforming their health insurance markets that are mandatory for plan years 2014-16.

It’s a big deal because it allows states to dispense with several of the Affordable Care Act’s health insurance market reforms starting in 2017 including the shared responsibility mandates and the requirement that all states have a health insurance exchange serving individuals and small employers. But states must first persuade the federal government they can operate their own state programs providing coverage on a par with value and affordability as under the Affordable Care Act requirements. If successful, states would be eligible for federal funding for their proposed programs.

 


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. 

Anthem Blue Cross California rate hike for grandfathered individual plans points up adverse selection risk

In the Anthem case, these are “grandfathered” policies purchased prior to the 2010 federal health law being enacted. They don’t comply fully with the Affordable Care Act, but consumers can hold on to them as long as they don’t make major changes in deductibles or other benefits.

Jones said Anthem’s practice of imposing hefty increases year after year suggests that the company wants to push these customers into newer policies “with narrower networks and potentially less access to medical providers.”

The insurer attributed the rising premiums to an aging customer pool “because new younger, healthier members are not able to sign up for grandfathered plans.”

via Anthem rate hike excessive for 170,000, regulator says – LA Times.

 

The last sentence tells much of the story from Anthem’s perspective. Grandfathered plans — those that were in place when the Patient Protection and Affordable Care Act was signed into law in March 2010 — are separately pooled and not part of the single statewide risk pool put in place under the Affordable Care Act’s reforms of the individual and small group health insurance markets. They are also known as non-ACA compliant plans.

Since younger adults who are entering the reformed individual market aren’t being included in the grandfathered plans, their lower expected medical utilization can’t aid in the spread of risk for grandfathered plans and potentially subjects those plans to adverse selection risk. As the Los Angeles Times article reports, California’s insurance commissioner has a different perspective on the rate increase.

 


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 health benefit exchange rebrands SHOP, possibly setting stage for merger of individual and small group exchanges

California could be setting the stage to merge its individual and small business health benefit exchanges by moving to rebrand its Small Business Health Options Program (SHOP) under the brand name of its individual exchange, Covered California. It will be dubbed Covered California for Small Business, according to this report by the Sacramento Business Journal.

State health benefit exchange SHOPs serve small employers — currently those employing 50 or fewer employees and those with 100 or less starting for plan years beginning in 2016.

Section 1311(b)(2) of the Patient Protection and Affordable Care Act gives states the option to merge their individual and SHOP exchanges. States may also merge their individual and small group markets under Section 1312(c)(3) of the law “if the State determines appropriate.” California law establishing the state’s exchange mandates it report to the Legislature by December 1, 2018, on whether to exercise that option taking into account the potential impact on premium rates paid by individuals and small employers in a merged market as compared to keeping the markets separate.

 


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. 

Vermont mulls working with nearby states on health benefit exchange enrollment, call center

Lt. Gov. Phil Scott, senators explore alternative to Vermont Health Exchange – VTDigger.

The VTDigger reports Vermont officials are considering partnering with adjacent states or sharing vendor resources for its health benefit exchange eligibility and enrollment and call center functions as an alternative to partnering with the federal government to support its state-based exchange as have Oregon, Nevada and New Mexico.

 


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. 

2015 crucial year for future of state health benefit exchanges

This year will prove a crucial one for the future of state health benefit exchanges. Under the Patient Protection and Affordable Care Act, the exchanges are mandated in all states for three years: 2014 through 2016. After that, the states can petition the U.S. Department of Health and Human Services for waivers to set up their own state plans provided the plans conform to the law’s requirements for scope of benefits and access and affordability for individuals and small employers.

How two issues will play out in 2015 will determine how the health benefit exchange marketplace will shape up later this year and during its final mandatory year of operation next year.

The first issue is the widely covered case (King v. Burwell) awaiting a ruling from the U.S. Supreme Court on whether the Obama administration’s regulations on advance tax credit premium subsidies comply with the Affordable Care Act and specifically whether the subsidies are available in states that did not establish an exchange via state action. There’s an outside chance the high court could rule the subsidies cannot be offered in those state exchanges, which many observers conclude could be so disruptive that it could call into question the future viability of the exchanges in those three dozen states.

Secondly, half of the states that did establish an exchange through state action – known as state-based exchanges or SBEs– face significant questions as to the sustainability of their SBEs relative to their financial and/or information technology implementation capacity. These include SBEs in Colorado, Washington, Hawaii, Minnesota, New Hampshire, Rhode Island and Vermont.

 


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. 

New eBook: Greater adoption of information and communications technology for knowledge work supports healthier lifestyles

As I’ve noted on this blog in the past, a major factor driving the health insurance crisis is preventable chronic conditions that can be avoided with greater individual investment in health promoting activities such as getting sufficient amounts of exercise and sleep and eating a healthful diet.

The commute-to-sit-in-an-office-or-cubicle lifestyle, where most waking hours are spent sitting, tends to work against this. It is linked to poor health and well-being because of the lack of time for meaningful daily exercise. Toss in too little sleep and frequent consumption of fast food and takeout meals during the workday and after work and we have the ingredients of the unhealthful lifestyle of all too many office workers.

Maintaining good health is the number one responsibility they owe themselves, their families and their organizations and clients. But ultimately, this is an individual responsibility and not that of their employers, health insurance plans, or healthcare providers. Organizations must afford knowledge workers the maximum ability to exercise—literally—responsible lifestyle choices to honor that obligation. In turn, employers will reap reduced healthcare costs, lower employee turnover, and improved staff attraction and retention.

Fortunately, broader adoption of today’s communications and information technology can free up the time office workers need to more fully invest in healthful lifestyles. Now nearly any setting can function as an office provided people can concentrate on their work, collaborate with colleagues and be productive.

My new eBook, Last Rush Hour: The Decentralization of Knowledge Work in the Twenty-First Century, describes the forces driving this trend and how it will benefit individuals and organizations and ultimately how it will impact where people choose to live and work.

The book is thoroughly researched, containing nearly 100 reference citations. Last Rush Hour is available through all major online book retailers including Amazon, iBooks, Barnes & Noble and other online eBook retailers.

 


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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