The note-taking Disease Management Care Blog attended the World Congress Leadership Summit on Health Care Reform today. Thanks to a day of keynote presentations, panel discussions and audience questioning, the DMCB culled some of the more interesting pointers from the presenters State regulation of health insurance rates – to make sure they are reasonable – also means State responsibility for solvency. If a health insurer has to declare insolvency/bankruptcy, it’s up to the regulator to clean up the mess, which means helping to settle any outstanding claims. Up until now, that’s been a State budget issue. Members of the National Association of Insurance Commissioners (NAIC) fear Federal meddling in setting insurance premiums too low could eventually lead to some health insurers going out of business, leaving it up to the State taxpayers to have to step in.
Elements of health reform from 2012 to 2017 are vulnerable to two election cycles, one of them involving the Presidency. A lot can change between now and then.
Many employers are looking at the coming administrative hassles of providing health insurance and they don't like what they see. Dropping out and pushing employees into the State exchanges could lead to higher-than-expected number persons into the individual market, which may mean a need for higher-than-expected subsidies.
Health insurers in the individual market in Idaho and Maine are or will ask CMS for waiver of the 85% MLR rule.
Prior to passage of the Affordable Care Act (ACA), health insurers were required to convert to ICD-10-based claims systems. This considerable additional administrative expense is unfolding at the same time that the ACA is forcing insurers to maintain their medical loss ratios (MLRs) at 80% to 85%.
Thousands of self-insured employers, who pay claims every day, don’t buy the hard-ball demonization of the health insurance industry by the Obama Administration.
At the same time that the United States’ gross domestic product tanked, hospital prices increased.
Facing a death spiral in the face of looming guaranteed issue regulations, there are rumors that commercial health insurers are exiting the “child only” insurance market.
If the DMCB doesn't have it right, misheard or if anyone can clarify, please share.