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Individual health insurance reform weekly august 29

Posted Mar 17 2012 6:17am
Week of August 29, 2011 The Congressional Budget Office (CBO) last week released an updated report on the nation's budget and economic outlook that comments on a number of health care policy issues. First, the CBO says that if another physician payment "fix" is enacted by Congress (as has happened every year since 2003), then spending on Medicare could be significantly more than the amount projected in CBO's baseline. Under current law, Medicare physician payments rates are scheduled to be reduced, but if those rates stayed the same through 2021 then Medicare outlays over the next 10 years would be $300 billion more than projected. The CBO also estimates that federal Medicaid spending will increase by less than 1 percent this year, compared to an average annual increase of 8 percent between 2000 and 2009. The slowdown is due to the expiration of increased federal assistance to the states for Medicaid in 2009 and 2010. Finally, CBO is anticipating a one-year delay in the implementation of the Community Living Assistance Services and Supports (CLASS) Program created under the Affordable Care Act (ACA). CBO projects the program won't begin collecting premiums until 2013. Some in Congress have called for repeal of the ACA provision creating the CLASS program because of its long-term cost. States Aetna participated in one of two "Exchange Listening Sessions" hosted by the Department of Health and Human Services (HHS) for community organizations and nongovernmental stakeholders. The meeting opened with an overview of the Notices of Proposed Rule Making (NPRM) on Exchanges, Plan Standards, Eligibility and Enrollment; Medicaid Eligibility and Enrollment and Tax Credits. Comments from advocacy groups essentially called for the following: Seamless interfacing of the eligibility system for Medicaid recipients, particularly the population impacted by the coverage expansion Credentials of Navigators (requiring more from community groups to avoid broker dominance) Parameters to constrain states from using flexibility as a guise to retreat from ACA requirements Improved foreign language translations of the material on the HHS website Stricter scrutiny of exchange board membership Alignment of Medicaid eligibility/enrollment rules with an exchange open enrollment period Integrating the exchanges with other public service agencies Requiring all carriers to contract with essential service providers Joel Ario, Director, Office of Health Insurance Exchanges, remarked that the overarching goal of the exchanges was to expand consumer protections through greater transparency. His response to concerns about adverse selection was to point to the availability of the "young invincible" policy and the "3 Rs" -- risk adjustment, risk corridors and reinsurance -- as solutions. Regarding the potential for exchange products to not be affordable, Ario said the goal of the exchanges is solely to expand access and that the cost issue will be addressed by exchanges becoming "active purchasers".CALIFORNIA: As expected, consumer groups are threatening to push for a measure on the November 2012 ballot that would let voters decide on whether rate regulation of health insurance premiums should be allowed. Consumer groups plan to prepare the ballot language and submit the measure to the state Attorney General by November. Then the group will start collecting the 700,000 signatures necessary to qualify for the ballot. Exactly what the ballot language would require is not yet known, but it would likely look similar to legislation currently pending in the legislature. The legislation would require prior approval of all health insurance rates, payment of intervener fees, approval of employer benefit design changes and rate rollbacks. Consumer groups seem to be turning their attention toward a potential ballot measure rather than the legislative vehicle since the bill has come under strong opposition from not only health insurers and business groups but also CalPERS, the League of Cities and the State Department of Finance. Ads by Google In other news, the California Health Exchange Board selected Peter Lee as its Executive Director. Most recently Lee was deputy director for the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services. Lee previously served as executive director and CEO of the Pacific Business Group on Health. That role is similar to the one that the exchange is expected to play on behalf of individuals and small businesses.IDAHO: The legislature's interim Health Care Task Force met last week to address issues that include federal health care reform and the future Idaho Health Insurance Exchange. Despite his hostility toward federal health care reform and his executive order prohibiting many activities that would implement the ACA, Governor C.L. "Butch" Otter indicated that the state would continue efforts to establish an exchange. Otter argued in support of the state's acceptance of federal grant money to establish the exchange, stating that Idaho could see the loss of significant federal funds without quick action. Otter pointed out that failure to establish a state-based exchange would devastate health insurance agents in the state and would allow the federal government to dictate health insurance policy for Idaho. Noting that he does not need approval from the task force or legislature to apply for the grant money, the governor indicated that he had made the decision to pursue federal funds for an exchange. Following the governor, representatives from the Idaho Department of Health and Welfare (Richard Armstrong, Director) and the Idaho Department of Insurance (Bill Deal, Director) made the case that action is necessary to address unsustainably high health care costs and inefficiencies in the marketplace. Specifically, they argued that operating the exchange at the state level allows the state to continue to govern the market, decide which carriers participate and pursue state-specific policies to assure competition and choice. According to regulators, the planning process for the exchange is underway and has thus far focused on obtaining stakeholder input and developing background research. Armstrong and Deal pointed to four potential courses of action for the state: apply for funding for an Idaho exchange; wait for lawmakers to decide options for an exchange; return/accept funding for an Idaho exchange based on state decisions; and decline to pursue additional federal grants, forfeiting the opportunity to decide on an exchange at a later date.MICHIGAN: A 1.0 percent medical claims tax has passed both houses of the legislature and is now headed to Governor Rick Snyder for his signature. Having originated the idea in the Administration's initial budget, the governor is fully expected to sign it. The tax replaces the existing 6 percent tax on the state's Medicaid HMOs and the $1.2 billion it raises for the Medicaid program. The law allows for a maximum of $400 million to be collected from the medical claims tax, which would permit the state to receive another $800 million in federal matching Medicaid dollars for calendar years 2012 and 2013. Aetna argued against the legislation, as did many Aetna customers. The tax was not defeated, but opponents were able to mitigate portions of the tax, including: 1) the sunset date was moved up from 2016 to January 1, 2014; 2) the start date for tax payments was moved back to 30 days after the end of a quarter rather than payable monthly beginning in October 2011; and 3) a hard cap of $400 million is ensured in 2012 and $400 million with medical inflation in 2013, rather than a soft cap that could have potentially made payers liable for millions more each year.NEW JERSEY: Last week the state Senate took action on a bill that would create the New Jersey Health Care Reform Implementation Council, with the intent of positioning the state to comply with new health care reform rules and regulations and reap additional federal assistance. The newly established council would be a 29-member panel of experts, policymakers, health care providers, academics and advocates to make recommendations for keeping New Jersey in compliance with federal health care reform and ensure the state maximizes federal aid. Under the bill, council members would serve for a period of five years, with the expiration of the first term in office staggered to continue the operations of the council. The council would be required to report to the governor and the legislature annually as to their activities and policy recommendations. With the full Senate's approval, the bill now moves to the Assembly for consideration.OKLAHOMA: Insurance Commissioner John D. Doak recently commented on the existence of faith-based health care sharing ministries and his department's ability to respond to related consumer complaints. In the latest issue of the "Commissioner's Corner," Doak said that while faith-based sharing organizations might be an option to make health care more affordable, consumers cannot bring consumer complaints to the Oklahoma Insurance Department for resolution. Instead, they will have to settle any potential disputes with their health-care sharing ministry on their own. He encouraged consumers to consider this factor as they weigh the decision on whether to join a health-care sharing ministry.WASHINGTON: Governor Chris Gregoire has announced that she is bringing back Fred Olson as her deputy chief of staff. He served in that role until December 2006, when he decided to retire. Olson, is a former reporter and managing editor of The Olympian, and has held posts at the Attorney General's Office and Department of Ecology. WISCONSIN: The Office of Free Market Health Care (OFMHC) has released a report titled "The Impact of the ACA on Wisconsin's Health Insurance Market" that forecasts specific impacts on the individual and small group markets through 2016. The Department of Health Services contracted with Gorman Actuarial, LLC and Jonathan Gruber of MIT in 2010 to conduct the report. The report includes the following findings: 1) by 2016, the number of uninsured is projected to decrease by 340,000, or 65 percent; 2) 57 percent of the individual market (91,000 members) will be eligible for tax subsidies within the exchange; 3) the individual market will experience premium increases as compared to pre-reform premiums; 4) after the application of tax subsidies, 41 percent of the individual market will experience premium decreases as compared to pre-reform premiums; 5) the merging of the individual market with the HIRSP market will increase individual market premiums by 16 percent; 53 percent of the small employer groups will experience a premium increase as compared to pre-reform premiums; 6) in 2016 the traditional individual market will see an 83 percent decline, losing 150,000 members, while the newly reformed market will grow to 320,000 new enrollees. Beats by Dre Studio Detroit Lions Edition Limitée
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