Tag Archive: Center for Consumer Information and Insurance Oversight

Federal government liberalizes ACA definition of QHP to boost enrollment in troubled state exchanges

The U.S. Department of Health and Human Services’ Center for Consumer Information & Insurance Oversight issued guidance (.pdf) this week aimed at boosting enrollments in six state health benefit exchange marketplaces hobbled by glitches in their online enrollment web portals. The guidance issued February 27, 2014 allows the marketplaces to deem individuals eligible for retroactive coverage back to January 1, 2014 if they meet eligibility requirements but were unable to enroll in a plan by the upcoming March 31 plan year 2014 enrollment deadline due to the technical problems with the portals – described as an “exceptional circumstance” in the guidance.

The federal guidance uses the exceptional circumstance declaration to get around the definition of a qualified health plan (QHP) at Section 1301 of the Patient Protection and Affordable Care Act as one certified by an exchange exclusively for sale on the exchange marketplace. The guidance does so by including those who enrolled in non-QHPs – plans sold outside the exchange marketplace. Those enrollees would then be potentially eligible for subsidies in the form of advance premium tax credits and cost sharing reductions that would not otherwise be available to them. According to The New York Times, Oregon Gov. John Kitzhaber requested the federal government to allow the premium tax credits for people buying insurance outside that state’s troubled exchange.

This limited relief from the March 31 deadline for plan year 2014 enrollment and the extension of premium tax credit and cost sharing subsidies to non-QHPs will take pressure off the six troubled state exchange marketplaces that due to enrollment shortfalls may be unable to support themselves financially starting in 2015 when federal establishment grant assistance ceases as required by the Affordable Care Act. For more on this, click here.

 


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. 

Health reform alters traditional state regulation of health insurers

The traditional role of state regulation of health insurance products is being transformed with the implementation of the Patient Protection and Affordable Care Act. Nearly three dozen states opting not to set up state-based health benefit exchange marketplaces are effectively ceding regulation of some or all elements of the individual and small group health insurance markets to the U.S. Department of Health and Human Services’ (HHS) Center for Consumer Information and Insurance Oversight. This Los Angeles Times article provides more detail.

The feds already have a large degree of premium rate oversight authority. 45 Code of Federal Regulations (CFR) Part 154 authorizes HHS to establish an annual rate review process to identify “unreasonable” health insurance rate increases. The regulation is enforced jointly by the feds and state regulators or solely by the federal government if states opt not to participate.

This raises questions regarding the future of state-based regulation of individual and small group health coverage. Will health care reform ultimately produce a hybrid of state and federal regulation? And since a majority of states is opting out of the state-based exchange marketplace, will it create momentum for a future shift to full federal regulation?

 


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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