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Timothy Jost Reviews What Four Years of the ACA Have Brought Us

"Although Jost suggests that the determination of the success or failure will be based on how successful the enrollment of the 50 million mostly lower-income uninsured Americans will be, it is more likely that those with incomes above 400 percent of the federal poverty level who will be bearing the full costs of their insurance, directly or through wage concessions, will consider the shift in employer-sponsored plans toward narrow networks and high cost sharing to be a failure of policy."

The Halbig Cases: Timothy Jost Responds

"There is in fact not a shred of evidence that Congress meant to limit tax credits to state-operated exchanges. The heads of the House and Senate committees that drafted the legislation, stated in briefs filed in court that the text, purpose, and history of the Affordable Care Act establish that both federally facilitated and state-operated exchanges are authorized to issue premium tax credits.... There is a school of thought, however, that believes that it does not matter what Congress means; all that matters is the language it uses in a law."

Leading ACA Columnist Passes Baton to New Author

"[Timothy Jost, in the Health Affairs Blog, chronicled] the development and eventual passage of the ACA. Then, he began doing [hundreds of] posts on the seemingly endless stream of rules, guidances, and other documents necessary to put the new law into action.... Tim will continue to write the monthly 'Eye on Health Reform' [column in] Health Affairs.... Katie Keith will [take over for Jost on the ACA column]."

Implementing Health Reform: Data Hub Security and Other Issues

"The hub will verify data provided by applicants against information in existing and secure federal and state databases, such as those of the [IRS], [SSA], the Department of Veterans Affairs, Medicare, and others. It will provide one highly secure connection to these databases rather than requiring each exchange to set up its own connections. The hub has several levels of protection to mitigate security risks. It employs a continuous monitoring model to rapidly identify and take action against irregular behavior and unauthorized system changes that could indicate a potential incident."

Supreme Court 'Church Plan' Decision and Pending Rule Will Affect Preventive Services Coverage by Group Health Plans

"The group health plan requirements of the [ACA] apply to church plans ... The government has consistently taken the position, however, that, because church plans are exempt from ERISA, it has no means of compelling the third party administrators of self-insured church plans to comply with the ACA, or at least its preventive services requirement.... The leaked contraceptive rule would effectively extend the exceptions that have excused self-insured church plans -- and churches -- from complying with the contraceptive [coverage] requirement ... If the rule that emerges from HHS is significantly narrower than the leaked version, more entities might rely on the Advocate Health Care ruling to claim the protection of the church plan exemption."

OPM Issues Proposed Regs on Participation in Health Exchanges by Members of Congress

"Only one group of Americans is required to purchase insurance through the exchanges: members of Congress and their personnel staffs (in Washington and in the districts, but not committee staff or other congressional employees).... The proposed rule provides, as expected, that the federal government will pay a share of exchange premiums, 72 percent of the cost of the weighted average of Federal Employee Health Benefit Program (FEHBP) plans or 75 percent of the premium of the chosen plan, whichever is less.... [T]he rule clarifies that plans that are certified as qualified health plans by an exchange will also qualify as 'health benefit plans' for FEHBP coverage. The federal government will, therefore, be able to make a contribution to cover a share of the premiums of an exchange plan."

GAO Issues Progress Report on Health Exchanges

"Under the best of circumstances, creating and implementing a program that will revolutionize the way in which individual and small group health insurance is underwritten and sold in the United States, providing financial assistance through the tax system and Medicaid to millions of Americans who cannot afford health insurance, and organizing health insurance markets to promote choice and competition -- and to do all this in the timeframe allowed by the ACA -- would have been a daunting task."

Progress, But Much Work Remains on Implementing Health Reform Rules: SBC FAQs for 2014

"The agencies had stated earlier that they would also change the form for 2014 to reflect the statutory elimination of all annual dollar limits on essential health benefits. The agencies are not making this change, but insurers or plans must state that no annual dollar limits are in fact imposed on essential health benefits. In a major disappointment to consumers, the agencies are not adding any new coverage examples for 2014."

Implementing Health Reform: Benefit and Payment Parameters Proposed Regs

"The notice of benefit and payment parameters proposal is one of the longest regulatory issuances yet to emerge from the ACA implementation process -- 372 pages of preamble and regulatory text.... Viewed as a whole, the proposal illuminates more clearly than anything that has so far emerged from the implementation process what a monumental task Congress has set for the nation in trying to reshape a private, market-based, health insurance system to make it accessible to all but the poorest Americans, regardless of health status."

Health Reform: Reinventing the Wheel, Health Affairs Blog, October 12th, 2006, and Comment

Excerpt: The American health care systems perform impressively, producing what they are designed to deliver: cost inflation, inefficiency, and inequity. [Alan Maynard writes on Porter and Teisberg's reinvention of the health care system wheel.]

CMS Threatens New York Basic Health Program with Big Cut

"CMS's position is apparently that if the Congress does not fund the cost-sharing reductions (CSRs), New York is not due 95 percent of CSR payments. It would seem that New York and its [Basic Health Plan (BHP)] insurers could do in response what most other states have done -- simply increase premiums to cover the lost CSR payments, thus increasing the premium tax credit pass-through payments. It may be too late to do this for 2018, however, if rates are already set and cannot be changed."

Senate GOP Leadership Unveils Latest Version of Health Reform Legislation

"The Cruz amendment provides that an insurer could offer 'skinny' plans that do not comply with ACA requirements in a rating area for a plan year, as long as the insurer certified to HHS that it would make available at least one gold plan (80 percent actuarial value), one silver plan (70 percent actuarial value), and one plan with an actuarial value of 58 percent (the new benchmark level for determining premium tax credits) in the entire rating period for the plan year.... The July 13 amendment provides $70 billion for state stability funds. For the years 2020 to 2026, the Cruz amendment would require HHS to pay these funds to insurers that offer ACA compliant plans ... States with skinny plans could use money they receive under the stability fund to reduce premiums for ACA compliant plans."

A Closer Look at House GOP Bills on Stop-Loss Coverage, Wellness Programs, and Association Health Plans

"These bills are not part of the American Health Care Act ... They are therefore very unlikely to be enacted into law because they cannot be passed by the Senate without the support of at least 60 senators. There are intimations, however, that the bills may be passed by the House in conjunction with the AHCA, and thus they are worthy of a closer look."

Taking Stock of Health Reform: Where We've Been, Where We're Going

"This [article] will describe and assess the ACA in its sixth year, its successes and failures. It will next consider how the new administration might proceed with repealing and replacing it. Finally, it will examine the provisions that the new Congress and administration may adopt to try to replace the ACA and assess how they might improve on or undermine the ACA's accomplishments. This assessment will focus on the effects of the ACA and its likely replacements on accessibility and affordability."

New Rule on Excepted Benefits, Short-Term Coverage, FAQs on Mental Health and Substance Use

"The final rule adopts essentially unchanged the portions of the proposed rule it covers. However, two of the topics addressed by the proposed rule -- group fixed dollar indemnity coverage and expatriate plans -- are not being finalized at this time. The final regulations also do not address specified disease policies (such as cancer policies), a topic on which the departments had requested comment in the notice of proposed rulemaking."

House v. Burwell and Qualified Health Plan Insurers for 2017

"If the House ultimately prevails in this litigation, funding for reimbursing insurers for reducing cost sharing for their eligible enrollees could be terminated. A House victory would not, however, terminate the obligation of QHP insurers to reduce cost sharing, which would leave the insurers with substantial obligations not covered by their premiums."

CMS Releases Draft Call Letter for Quality Rating System (QRS) and Qualified Health Plan (QHP) Enrollee Experience Survey

"The QRS and QHP Enrollee Experience Survey are used to derive a star rating that will be displayed ... on the marketplace shopping site to signal to consumers the quality of the alternative health plans available to them. The call letter proposes an annual call letter process for future years and minor changes for the 2017 and 2018 rating years.... The 2016 draft call letter also proposes a few refinements for data collection during the 2017 ratings year."

Affordability: The Most Urgent Health Reform Issue for Ordinary Americans

"While the Affordable Care Act (ACA) has made health insurance more affordable for the uninsured, premiums and cost-sharing are still too high for many Americans. And cost-sharing has been edging ever higher for the majority of Americans who have coverage through employer-based plans. This post examines the affordability problem and offers suggestions for tackling it that combine approaches in the ACA with proposals by the law's detractors."

Implementing Health Reform: Reference Pricing and Network Adequacy

"On October 10, 2014, the Departments of Labor, Treasury, and Health and Human Services issued a frequently asked question (FAQ) regarding the use of reference-based pricing in non-grandfathered large group employer plans. Although the issue the FAQ addresses specifically is the use of reference pricing, the FAQ is remarkable insofar as it is the first departmental guidance that [the author is] aware of that addresses the use of networks by self-insured ERISA plans."

Recent CMS Releases: Medicaid and CHIP Enrollment, Data Verification, and Applications for 2015 Qualified Health Plans

"The instructions cover the 13 areas of requirements that QHP applicants must meet, including, for example, licensure, accreditation, actuarial value, network adequacy, prescription drugs, plans and benefits, and others. Also included in the release are rating tables and rating business rules insurers must follow, as well as forms to be used for insurers to provide justifications if issues arise from their application, such as cost sharing or formulary outliers.... [T]he 65-page section on plans and benefits ... sets out the elements that CMS expects will be shown to consumers in 'plan compare' on healthcare.gov for 2015."