More Than Half Of Individual Health Plans Offer Coverage That Falls Short Of What Can Be Sold Through Exchanges As Of 2014

The Affordable Care Act creates state-based health exchanges that will begin acting as a market place for health insurance plans and consumers in 2014. This paper compares the financial protection offered by today’s group and individual plans with the standards that will apply to insurance sold in state-based exchanges. Some states may apply these standards to all health insurance sold within the state. More than half of Americans who had individual insurance in 2010 were enrolled in plans that would not qualify as providing essential coverage under the rules of the exchanges in 2014. These people were enrolled in plans with an actuarial value below 60 percent, which means that the plans covered less than that proportion of the enrollees’ health expenses. Many of today’s individual health plans are below the “bronze” level, the lowest level of plan that can be sold through exchanges. In contrast, most group plans in 2010 had an actuarial benefit of 80–89 percent and would qualify as highly rated “gold” plans in the exchanges. To sell to ten million new buyers on the exchanges, insurers will need to redesign benefit packages. Combined with a ban on medical underwriting, the individual insurance market in a post–health reform world will sharply contrast with the market of past decades.

via More Than Half Of Individual Health Plans Offer Coverage That Falls Short Of What Can Be Sold Through Exchanges As Of 2014.

Jawboning by HHS doesn’t scare insurers – Jason Millman – POLITICO.com

The Department of Health and Human Services isn’t that much of a bully, it turns out.

Health insurers flagged by the department for “unreasonable” premium hikes are refusing to back down in the first year of HHS’s new rate review authority.

via Jawboning by HHS doesn’t scare insurers – Jason Millman – POLITICO.com.

New Rulemaking Tracker Makes Obamacare Easier to Digest – PR.com

Enter Knowledge Mosaic Inc. The Seattle-based vendor of legal and federal regulatory information has created a new online tool, the Affordable Care Act Rulemaking Tracker (ACA Tracker). Patterned after their popular Dodd-Frank Rulemaking Tracker and part of their Knowledge Mosaic subscription service, the ACA Tracker allows government, attorneys, professionals at affected companies, lobbyists, journalists, healthcare administrators, and anyone else who may need to stay abreast of new and proposed rules resulting from the Act to make sense of what is going on.

“The ACA Tracker creates a suite of regulatory tracking tools that contribute enormously to our pathbreaking project to map the entire federal regulatory landscape,” said Knowledge Mosaic President Peter Schwartz.

via New Rulemaking Tracker Makes Obamacare Easier to Digest – PR.com.

Health Insurers Plan Over $1 Billion in Rebates – WSJ.com

The nonpartisan Kaiser Family Foundation, which calculated total rebates at $1.3 billion, says that around $426 million will go to people who bought their own health plans; $541 million will go to large employers; and $377 million to small businesses.

In a separate analysis based on the same filings, Goldman Sachs analyst Matthew Borsch estimated the total rebates at around $1.2 billion.

via Health Insurers Plan Over $1 Billion in Rebates – WSJ.com.

New Data: The Affordable Care Act in Your State | The White House

Thanks to the Affordable Care Act, Amy is one of 105 million Americans – and nearly 1.2 million Iowans – with private health insurance who no longer will face lifetime limits on their care. You can read the Department of Health and Human Services’ latest research on the number of people who no longer have a lifetime limit on their insurance plan here.

This lifetime limit ban is just one of many new consumer protections created by the new law. Annual dollar limits on coverage are being phased out. And 54 million Americans received new coverage of prevention without cost sharing in 2011.

Today, the Obama Administration released a new source of data, Health Reform: Results in Your State, to show how the law’s benefits and protections are helping Americans across the country. To see how many people in your state are benefiting from the Affordable Care Act, click here (23.5KB XLSX file).

via New Data: The Affordable Care Act in Your State | The White House.

Federal Loan to Boost New Cooperative Health Insurers – Philanthropy Today – The Chronicle of Philanthropy- Connecting the nonprofit world with news, jobs, and ideas

Nonprofit health-care cooperatives in eight states will receive $638-million in federal loans to begin offering insurance to individuals and small businesses, according to the Associated Press.

The financing, announced by the Obama administration on Tuesday, arises from the federal health-insurance law mandating coverage for the uninsured by 2014. The consumer-run co-ops in Iowa, Montana, Nebraska, New Jersey, New Mexico, New York, Oregon, and Wisconsin will compete for customers in state-run insurance exchanges, with an aim of keeping pressure on private firms to hold down prices.

via Federal Loan to Boost New Cooperative Health Insurers – Philanthropy Today – The Chronicle of Philanthropy- Connecting the nonprofit world with news, jobs, and ideas.

Insurers to rebate consumers $323M this year – FierceHealthPayer

Insurers must start disclosing information regarding insurance coverage they provide to their consumers and, if they spend less than 80 percent of premium dollars on healthcare, they must rebate consumers. The U.S. Department of Health and Human Services predicts that insurers will be returning about $323 million to consumers this year, according to UPI.

via Insurers to rebate consumers $323M this year – FierceHealthPayer.

Obama administration concludes healthcare law waiver review – The Hill’s Healthwatch

The Obama administration on Thursday denied Wisconsin’s request for a waiver from the healthcare law’s medical loss ratio, while partially approving North Carolina’s.

With the two decisions, the Department of Health and Human Services has concluded its review of the 17 states that have requested a waiver from the law’s requirement that individual market insurance plans spend at least 80 percent of premiums on medical care or give customers rebates.

HHS has rejected 10 requests and approved modified applications from seven states.

via Obama administration concludes healthcare law waiver review – The Hill’s Healthwatch.

Regulating Stop-Loss Coverage May Be Needed To Deter Self- Insuring Small Employers From Undermining Market Reforms

As implementation of the Affordable Care Act reshapes the US health insurance market, state policy makers should be prepared to revisit regulation of stop-loss coverage—a form of reinsurance—for small businesses. Aspects of the reform law could motivate small businesses to self-insure, rather than participate in state-regulated markets either inside or outside the new health insurance exchanges. If younger or healthier groups self-insure, premiums for insured plans might rise to an extent that could seriously impair the regulated market. States can influence small businesses to participate in the regulated market by making it more difficult or costly to obtain stop-loss coverage, which self-funded employers rely on to protect their businesses from catastrophic medical costs incurred by one or more insured workers. States can limit the comprehensiveness of stop-loss coverage, ban stop-loss coverage outright, or regulate it as they do primary coverage. But states need federal guidance about how to exercise this authority if they are to promote, or prevent the undermining of, important aspects of federal health care reform.

via Regulating Stop-Loss Coverage May Be Needed To Deter Self- Insuring Small Employers From Undermining Market Reforms.

Beware the Rush to Presumption, Part B | Mercatus

Federal agencies issued eight major interim final regulations in 2010 to quickly implement major provisions of the Affordable Care Act (ACA). This paper employs the Mercatus Center’s Regulatory Report Card scoring system to compare the quality and use of regulatory impact analyses (RIAs) for these regulations with the quality and use of RIAs for major proposed regulations in 2008 and 2009.

The quality and use of analysis for the ACA interim final regulations falls well below the standards set by other agencies and even by the U.S. Department of Health and Human Services in conventional notice-and-comment rulemaking in previous years. The analysis in the eight ACA RIAs is comparable to the analysis that accompanied a series of interim final homeland security regulations issued by the Bush administration following 9/11. This suggests that institutional, rather than personal or partisan, factors explain why the quality of regulatory analysis declines when agencies implement significant presidential priorities on short deadlines.

via Beware the Rush to Presumption, Part B | Mercatus.