Tag Archive: state exchange marketplace

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

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. 

ACA’s individual, employer mandates aimed at frayed edges of U.S. private health coverage

Daniel Weintraub penned an opinion piece appearing in today’s Sacramento Bee that laments the likely continuation of employer-sponsored health coverage under the Affordable Care Act – notwithstanding the Obama administration’s decision this month to delay enforcement of penalties against employers of 50 or more who don’t offer their employees health coverage meeting minimum standards of quality and affordability.  Weintraub argues – and many across the political spectrum would agree with him – that employers shouldn’t be in the business of providing health coverage to their employees (and might not be, but for a 1940s quirk of history) and that it should be left to individuals and families to buy what’s best for their needs. In this vein, Weintraub favors a 2011 proposal to amend the ACA to allow employees of companies with 100 or fewer workers to take their employer’s health care contribution and buy coverage in the state health benefit exchange marketplace.

That sounds a lot like an existing provision at Section 10108 of the ACA that allows employers to provide “free choice vouchers” to their employees to buy coverage on the exchange marketplace.  Employers however would still have to offer their employees minimum essential coverage and could only offer the vouchers to employees whose share would be between 8 and 9.8 percent of their household income. Plus the employee’s household income could not exceed 400 percent of the federal poverty limit.

The debate over both the employer and individual mandate is heating up again, a little more than a year after the U.S. Supreme Court upheld the constitutionality of the latter in NFIB v. Sebelius.  Both mandates are aimed at the frayed edges of the pre-ACA health insurance market and don’t affect the majority of Americans covered through their employers or government programs such as Medicare and Medicaid. In the large group market, the employer mandate is directed at a small minority of large employers that pay low wages and provide little in the way of health benefits. At the other end of the market, the individual mandate hopes to help restore that market segment to actuarial and functional health. Both are governmental market interventions intended to trim these rough, problematic margins of the current system of private health coverage.  Whether they are ultimately successful won’t be known for several years.

 


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 data hub IT readiness likely factor in delay of large employer health coverage offer mandate

Employer push back on the complexity of requirements for reporting information on employer sponsored health plans was cited by the Obama administration for this week’s announcement by the U.S. Treasury Department of a one year enforcement delay for the Affordable Care Act’s “shared responsibility” provision requiring employers of 50 or more workers to offer minimum, affordable health coverage to full time employees.

But there’s likely another and just as important factor. It’s the federal government’s IT integration project to create a “data services hub” that pulls together information from multiple federal agencies to help determine the eligibility of an applicant for health coverage in the state health benefit exchange marketplace.

The federal hub interfaces with state insurance assistance programs for the poor including Medicaid and the Childrens Health Insurance Program.  It also should include a dataset of employer-sponsored health coverage to help exchanges determine if an employed applicant for individual coverage is already offered qualifying employer-sponsored coverage and thus ineligible to purchase an exchange plan that comes with advance tax credit subsidies.

IT experts agree integrating all of these data sets as well as often outdated state program software platforms in order for state exchange eligibility workers to make a quick, “one touch” eligibility determinations is an IT integration challenge of enormous proportions that would normally take years to implement. However, in order for the system to be ready to go live when exchange enrollment opens October 1, all of these data sets would have to be integrated and operational in July for testing and debugging.  It’s now July and most likely that deadline isn’t going to be met.

The federal government’s announcement noted proposed rules are forthcoming this summer governing employer sponsored health plan reporting requirements. It hinted the regulations will allow for self certification (the key word is “voluntarily”) by employers of their sponsored employee health coverage for 2014, while at the same time giving IT integrators another year to prepare the federal data hub to include this data set in time for 2015:

Once these rules have been issued, the Administration will work with employers, insurers, and other reporting entities to strongly encourage them to voluntarily implement this information reporting in 2014, in preparation for the full application of the provisions in 2015.  Real-world testing of reporting systems in 2014 will contribute to a smoother transition to full implementation in 2015.

Update:  On 7/5/13, the federal Department of Health and Human Services published in the Federal Register an extensive final rulemaking that allows exchanges that do not have information on employer-sponsored coverage obtained from electronic data sources or the SHOP exchange to accept an individual applicant’s self attestation that their employer does not offer them minimum affordable coverage (subject to possible future reconciliation of advance tax credits) and authorizes exchanges to investigate inconsistencies for individual plans covering 2014.

The final rule also gives exchanges the option of relying on HHS to verify an employed applicant’s eligibility for advance tax credit and cost sharing subsidies in 2015 and later.  The relevant provisions are effective September 15, 2013 and codified at 45 CFR 155.320(d), Verification related to enrollment in an eligible employer-sponsored plan and eligibility for qualifying coverage in an eligible employer-sponsored plan.

 


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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