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Posts Tagged ‘exchange marketplace’

R.I. health benefits exchange may provide fiscal relief to municipalities | Breaking News | providencejournal.com | The Providence Journal – The Providence Journal

September 13th, 2013 Comments off

Cash-strapped jurisdictions from Detroit to Sheboygan County, Wis., are considering moving retirees into Obamacare marketplaces as a way to reduce costs.

Detroit has proposed the option as it seeks to emerge from the largest municipal bankruptcy in U.S. history.

And Chicago plans to reduce health insurance coverage for tens of thousands of retired city workers next year. The city expects those retired workers would be able to purchase government-subsidized health care through Illinois’ Obamacare exchange.

via R.I. health benefits exchange may provide fiscal relief to municipalities | Breaking News | providencejournal.com | The Providence Journal – The Providence Journal.

State health benefit exchanges could end up getting significantly larger than predicted enrollment numbers if this cost shift takes off.  Lots of government employees retire before they become eligible for Medicare at age 65.  Health plans could also end up with more older people in their state individual market risk pools than forecast, leading to higher than expected costs. However as suggested in the article, moving government retirees into the exchange marketplace may not come without a legal fight over labor contract provisions governing retirement benefits.

 


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. 

Will individuals ineligible for exchange premium subsidies turn to catastrophic plans?

August 27th, 2013 Comments off

Less than half (48 percent) of Americans who currently buy health coverage for themselves and their families in the individual market will qualify for advance tax credits to subsidize coverage purchased in the state health benefit exchange marketplace, according to a Kaiser Family Foundation paper issued this month. (That figure does not include those who qualify for Medicaid coverage in states that elect to expand coverage for households earning up to 133 percent of the federal poverty level.) The exchange advance tax credit subsidy is available in six income tranches for those with incomes between 100 and 400 percent of the federal poverty level. Those earning more than 400 percent of the federal poverty level ($45,960 for singles; $92,200 for a family of four) are ineligible for the subsidies.

A big question as the exchanges prepare to open for 2014 enrollment this October is to what extent this cohort will find their premiums exceed eight percent of their incomes. The Affordable Care Act and implementing regulations regard premiums at this level as unaffordable and exempt those meeting this test from the law’s individual responsibility requirement and associated penalties for not having coverage. They allow these individuals to obtain a certificate of exemption from state exchanges that entitles them to purchase lower cost “catastrophic” coverage on or off the exchange marketplace. (Pending California legislation, SB 639, would restrict off-exchange sales to plan issuers offering catastrophic plans through the exchange marketplace). Catastrophic plans must include the 10 essential benefits required for all individual plans beginning in plan year 2014 as well as at least three primary care visits – with a flat deductible of $6,250 for individuals and $12,500 for families.

Federal rules (45 CFR § 156.155(c)) specify that for family catastrophic coverage, each enrolled family member must meet the eight percent income to premium affordability exemption or be under age 30. Lower premiums for catastrophic plans would enable these individuals and families to avoid going without coverage in case of a major, unexpected accident or illness as well as potentially facing very costly standard hospital “rack rate” charges for those without insurance.

 


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. 

Congressional staff headed for enrollment in state exchange marketplace; some state and local government retirees could be next

August 8th, 2013 Comments off

Two types of government workers could end up getting health coverage through the state health benefit exchange marketplace.  The first is members of Congress and their staffs as mandated by the Patient Protection and Affordable Care Act.  The federal Office of Personnel Management issued a proposed rule this week that implements the requirement under which these individuals would use their existing employer contributions from the Federal Employees Health Benefits program to purchase exchange plans for coverage beginning in January 2014.

The other category is state and local government retirees who have not yet become eligible for Medicare. These early retirees could also end up in the exchanges as state and local governments struggle with ballooning deficits in retiree health funds that threaten their solvency.  The prospect is the topic of recent articles by Bloomberg and Governing magazine. The apparent thinking is a fair number of these pensioners on relatively modest fixed incomes would qualify for advance income tax credits to help them purchase an exchange plan and wouldn’t have to undergo medical underwriting under individual market reforms that take effect in 2014.

 


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. 

Paper discusses how states can share exchange marketplace knowledge, experience and functions

July 22nd, 2013 Comments off

As has been pointed out on this blog, the Affordable Care Act contains options for health plan issuers to sell plans across state lines as well as for state health benefit exchange marketplaces to form regional exchange marketplaces with other states.

For those interested in an in depth discussion of the potential areas of interstate cooperation in the exchange marketplace, the National Academy of State Health Policy has published a paper on the topic, State Sharing of Insurance Exchanges: Options, Priorities, and Next Steps from the West Virginia Regional Exchange Study.

The project was initiated and funded by West Virginia out of that state’s concern that its relatively small, poor health status population may not make for an actuarially viable exchange marketplace. The paper posits that the current federal partnership exchange model where the federal and state governments jointly operate the exchange may provide the best environment to explore and develop sharing functions among exchanges as the partnership exchanges consider becoming state-based or regional exchanges.

 


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. 

WellPoint’s Anthem Blue Cross spurns Calif. small-business exchange – latimes.com

July 19th, 2013 Comments off

Health insurance giant Anthem Blue Cross said it won’t participate in California’s new insurance market for small businesses.

Anthem, a unit of WellPoint Inc., is California’s largest insurer for small employers. This surprising move could hamper the state’s ability to enroll businesses in its new exchange called Covered California that opens Jan. 1 as part of the federal healthcare law.

Instead, Anthem said it will keep selling coverage to small firms outside the exchange in direct competition with the state-run market. Anthem also remains one of 13 health insurers that will offer policies to individuals in Covered California.

via WellPoint’s Anthem Blue Cross spurns Calif. small-business exchange – latimes.com.

This development isn’t a propitious one for the California Small Business Health Options Program (SHOP) exchange marketplace. Not having a payer with such a significant market share could make it harder for the SHOP to attract small employers. Unlike the individual exchange marketplace, the SHOP relies almost completely on market aggregation forces to improve affordability, competition and choice in this market segment. Covered California is expected to announce participating SHOP plans for 2014 early next month.

In 2011, the California HealthCare Foundation estimated Anthem Blue Cross had 22 percent of the Golden State’s small group market, covering 548,000 enrollees.

 

 


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. 

Iowa, South Dakota Blues Skip Obamacare Exchange Next Year – Capsules – The KHN Blog

July 15th, 2013 Comments off

The fewer insurers that sell through exchanges, the less competition there will be for customers through price and service. Many insurers are approaching the exchanges cautiously because of concerns that the technology may not be ready and that the first customers will be disproportionately sick and expensive, analysts say.

via Iowa, South Dakota Blues Skip Obamacare Exchange Next Year – Capsules – The KHN Blog.

This is the key paragraph of the story relative to its implications for these and other state exchanges next year, particularly in smaller states where the absence of a major plan issuer can adversely affect the ability of the exchanges to attract individuals and small employers.

Participation in the exchange marketplace is voluntary for sellers and buyers.  But it won’t function as intended to make coverage more affordable and of better value unless it can generate sufficient economies of scale from both sides of the market.

 


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. 

The New Economics of Part-Time Employment – NYTimes.com

July 3rd, 2013 Comments off

The New Economics of Part-Time Employment – NYTimes.com.

Economist Casey B. Mulligan runs the numbers and concludes that for many, part time employment may become a more attractive option when tax credit subsidies for health coverage purchased on state health insurance exchange marketplaces is factored in.

Part time employment has been on an uptick since the start of the economic downturn in 2008 as this NYT article notes.  However, many part timers would prefer full time positions and the health benefits that come with them.  The exchange subsidies could change the calculation and possibly not only make part time work more palatable but also reinforce its rise.

 


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. 

Risky Health Insurance Bets Could Backfire for Small Employers – Businessweek

June 22nd, 2013 Comments off

Risky Health Insurance Bets Could Backfire for Small Employers – Businessweek

Small employers lacking bargaining power with insurers have in recent years fled the small group health insurance market to escape rising premium costs by opting to self insure their workforces’ medical costs.  That trend is colliding with Affordable Care Act reforms designed to make small group coverage more accessible and affordable, in turn reducing the number of medically uninsured small business employees.  The two primary ACA reforms aimed at boosting the health and viability of the small group market: 1)Mandating insurers underwrite all small employers as a single risk pool and; 2) Requiring states to create separate small business marketplaces within their health benefit exchange marketplaces in order to aggregate small employers’ purchasing power.

Insurance market reforms such as these won’t be as effective if small employers don’t participate in the small group insurance market.  Less participation reduces the size of the small group pool — and potentially the ability of the Small Business Health Options Program (SHOP) in state exchanges to concentrate sizable numbers of small employers to drive a better deal with insurers on premium rates.

There’s another even more worrisome risk facing policymakers as this Businessweek article points out.  Small employers playing in both the insurance and self-insured markets and moving in and out of each depending on the health status and claims experience of their employees.  Doing so would provide them a means to create adverse selection against the insurance market by opting to insure when their medical claims costs rise and self insuring when claims costs are low.

State policymakers are addressing this concern by making self insurance a less palatable option for small employers based on model law adopted by the National Association of Insurance Commissioners limiting the use of stop loss coverage that covers self insured employers once medical costs reach a specified amount such as the Colorado measure mentioned in the Businessweek story and SB 161 pending before the California Legislature.

 


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. 

Absence of rules means Direct Primary Care Medical Home QHPs unlikely to be offered on exchange marketplace in 2014

June 7th, 2013 Comments off

An innovative type of health plan that bundles pre-paid primary and preventative care with catastrophic insurance coverage isn’t likely to be sold on state health benefit exchange marketplaces in 2014.

The reason is the federal Department of Health and Human Services (HHS) has not yet developed rules governing Direct Primary Care Medical Home Plans, recognized at Section 1301(a)(3) of the Affordable Care Act as qualified health plans (QHPs) eligible to be sold through the exchanges. However, Section 1301(a)(3) requires such plans meet HHS criteria. HHS has not yet issued regulations defining those standards nor any guidance indicating when the rules will be forthcoming.

In April of this year, the California HealthCare Foundation issued an issue brief on Direct Primary Care Medical Home Plans authored by Dave Chase noting these plans offer significant potential health care cost savings over all inclusive plans such as HMOs while providing economic incentive for primary care physicians – many of whom will be needed to care for new patients obtaining health coverage under the Affordable Care Act.

 


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. 

Washington exchange garners strong plan interest for individual market, but limited for SHOP

May 31st, 2013 Comments off

The Washington Health Benefit Exchange reports nine health plan issuers have filed with that state’s Office of the Insurance Commissioner (OIC) to offer 57 Qualified Health Plans (QHPs) totaling 229 plan options for individuals and families through Washington Healthplanfinder, the state’s new online health insurance marketplace.

Plan issuers however demonstrated less interest in participating in the exchange’s Small Business Health Options Program (SHOP).  SHOP plans will be offered in only some of the state’s counties beginning Oct. 1, 2013.  In a news release, the exchange cited limited carrier participation that did not allow the Exchange to offer SHOP coverage options statewide.  Kaiser Foundation Health Plan of the Northwest will offer SHOP coverage in a limited number of counties to be determined, according to the exchange.

“Like our individual market, the SHOP was prepared to be operationally ready on Oct. 1,” said Washington Healthplanfinder CEO Richard Onizuka. “Ultimately, insurers informed us their inability to participate was a resource issue,” Onizuka explained, adding that additional issuers have expressed interest in participating in the SHOP market starting October 2014.

 


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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