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Posts Tagged ‘Office of Personnel Management’

Measures would allow individuals to purchase small group plans sold by DC health benefit exchange and federal employee plan to fill gaps in state individual markets

June 5th, 2017 Comments off

Two measures were recently introduced in Congress to address gaps in the non-group medical insurance market by allowing individuals and their family members to buy into small group plans sold through the District of Columbia’s health benefit exchange’s Small Business Health Options Program (SHOP) if their state health benefit exchange offers no plans where they live.

The Health Care Options for All Act (S.1201, McCaskill) would require the Office of Personnel Management (OPM) to establish a mechanism for their enrollment. A companion measure to S.1201, H.R. 2770 (Loebsack) was introduced in the House June 2; text for the bill is not yet available. The DC SHOP currently offers coverage to members of Congress and their staffs as required by the Patient Protection and Affordable Care Act. The District of Columbia health benefit exchange, DC Health Link, is reportedly opposed fearing the proposal if enacted would turn the DC exchange into a de facto national high risk pool.

Section 1334 of the ACA authorizes OPM to contract with health insurance issuers or a group of affiliated plan issuers to offer plans in all states as of this 2017. While the intent is to ensure exchanges can offer plans in all areas, the “multistate plans” authorized by Section 1334 are available in less than half of the states.

The bills could raise objections from health plan issuers since they broadly organize their product lines as employer group or non-group (individual) coverage and risk rate, price and establish provider networks separately for each. In addition, the Affordable Care Act segregates small group and individual coverage into separate statewide risk pools. However, states may merge their individual and small group markets under Section 1312(c)(3) of the law “if the State determines appropriate.” ACA Section 1311(b)(2) also affords states the option to merge their individual and SHOP exchanges.

Another measure introduced in early May, (H.R. 2400, Issa) also disregards the distinction between the group and non-group market segments by allowing individuals who are not federal employees to enroll in the Federal Employees Health Benefits Program.

 


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. 

Multi-state plans fall short of nationwide availability

November 2nd, 2016 2 comments

President Obama and Democratic presidential candidate Hillary Clinton have called for a publicly operated health plan to offer individual coverage. The intent is to bolster coverage options that have dwindled in some states as health plan issuers rethink their individual market participation as well as to bring to bear market pressure on participating plan issuers to hold down premium rates.

One existing provision of the Patient Protection and Affordable Care Act designed to do just that is at Section 1334 of law. It creates federally chartered health plans overseen by the Office of Personnel Management (OPM) and authorizes OPM to contract with health insurance issuers (or a group of health insurance issuers affiliated either by common ownership and control or by the common use of a nationally licensed service mark) to offer plans in multiple states.

Under Section 1334, such plans are to be available in all states starting in 2017. Turns out that isn’t going to happen. According to this page at the OPM website, just 22 state exchanges will have multi-state plans for sale next year. That contradicts Section 1334(e), which mandates OPM contract only with multistate plan issuers offering plans in all states in 2017.

OPM issued guidance earlier this year explaining why the requirement cannot be met:

While section 1334(e) of the ACA authorizes OPM to contract with issuers that offer nationwide expansion of coverage over a four-year schedule, the law does not preclude OPM from contracting with issuers that offer fewer than the scheduled number of states in any given year. The statute establishes general authority for OPM to contract for at least two plans in each state, but does not mandate firm parameters for attaining nationwide coverage. It remains the goal of the MSP Program to provide nationwide availability of MSP options by an issuer or group of issuers.

However, the experience of the first three years of the program has demonstrated that providing nationwide coverage for any issuer or group of issuers is difficult to achieve. Moreover, the statute does not give the Director of OPM authority to compel any issuer to provide nationwide coverage or to participate in the MSP Program. Therefore, OPM will exercise administrative discretion in deciding whether to contract with an issuer or group of issuers who would like to participate in the MSP Program but who cannot commit to offering coverage in all 51 jurisdictions by the fourth year of their participation in the program.

In sum, OPM is saying Section 1334(e)’s requirement notwithstanding, if health plan issuers don’t want to play in all states, it cannot force them to given the Affordable Care Act’s recognition of health insurance markets as voluntary. Also, the realities of the individual market in 2017 substantially reduced the likelihood of plan issuers offering multi-state plans nationwide as they reassess their participation in the state individual health insurance markets and the exchanges 2017 and post.

 


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. 

Multi-state plan paradox

June 27th, 2014 Comments off

Because the BCBSA is offering at least two plans in each of the states, the requirements of the law are met even though the OPM has a contract with only one issuer. The OPM did not publicly state how many applicants applied to the MSPP. The selection of the BCBSA, although not surprising, may not do much to increase plan choice or competition in heavily concentrated markets. In all but a handful of states, the BCBSA-affiliated plans are already the most dominant plans in the individual market.

via Health Policy Briefs.

A paradox of the Patient Protection and Affordable Care Act is explained in this Health Policy Brief by the journal Health Affairs. Multi-state plans were intended to increase competition in individual health insurance, particularly in state markets with only a small number of plan issuers.  However, the market dominance of Blue Cross and Blue Shield plan issuers in most states — plan issuers affiliated with the Blue Cross Blue Shield Association (BCBSA) — allows an affiliated plan issuer to designate two plan offerings as multi-state plans without altering the market share of the blue plan issuers.

 


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. 

Final rule directs members of Congress, staffers to DC SHOP exchange

October 1st, 2013 Comments off

The Office of Personnel Management (OPM) has issued a final rulemaking to be published in the Federal Register this week that directs members of Congress and designated staffers who avail themselves of government funded premium contributions to obtain coverage through the District of Columbia health benefit exchange’s Small Business Health Options Program (SHOP).  The Patient Protection and Affordable Care Act requires each state exchange marketplace to establish a SHOP to offer employers of 50 or fewer employees qualified small group health plans.

OPM explained its reasoning in the preamble to the final rule:

The proposed rule was silent on whether eligible individuals would select qualified health plans through an Exchange in the individual or small group market by way of the SHOP. Because a Government contribution is, in essence, an employer contribution, the final rule clarifies that Members of Congress and designated congressional staff must enroll in an appropriate SHOP as determined by the Director in order to receive a Government contribution. SHOPs are designed to provide employer-sponsored group health benefits and are, therefore, the appropriate environment in which to provide an employer contribution to Members of Congress and congressional staff. Further, this ensures that Members of Congress and congressional staff do not have additional choices in the individual Exchanges with a Government contribution that other individuals lack. Given the location of Congress in the District of Columbia, OPM has determined that the DC SHOP, known as the DC Health Link Small Business Market administered by the DC Health Benefit Exchange Authority, is the appropriate SHOP from which Members of Congress and designated congressional staff will purchase health insurance in order to receive a Government contribution. OPM intends to work with the DC Health Benefits Exchange to implement this rule.

 


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. 

Exchanges await more info on Multi-State Plans, express doubt on their ability to foster competition

July 22nd, 2013 Comments off

This recently issued paper on payer participation and competition in the health benefit exchange marketplace authored by the Urban Institute and the Georgetown University Health Policy Institute mentions Multi-State Plans that the Affordable Care Act mandates be rolled out over a four-year period in all state health insurance exchange marketplaces. At least two of these plans must be offered in each state exchange marketplace; one must be a nonprofit and one cannot offer abortion services. On May 30, the White House announced the federal Office of Personnel Management — which will charter the Multi-State Plans that must be licensed in each state — is reviewing applications for more than 200 Multi-State plan options.

Here’s what the paper’s authors write on Multi-State Plans:

State officials in the study states are still waiting for more information from OPM with regard to Multi-State Plans. In general, state officials seem resigned to the fact that the MSP will not necessarily mean more competition, since the MSPs are expected to be national insurers that already have a presence in the states. Informants reported that they have hard time envisioning how, for example, a national Blue Cross Blue Shield plan could come into a state without essentially replicating the Blue Cross Blue Shield products within the state, assuming the MSP would have to use the Blue Cross network and provider payment rates.

 


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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