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Health plans - policy


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[Guidance Overview] The MacArthur Amendment Language, Ethnicity in the Federal Exchange, and Risk Adjustment Coefficients
"[T]he amendment would repeal the enigmatic language included in a March 23, 2017 amendment to the AHCA that would have allowed states, beginning in 2018, to define the essential health benefits for purposes of determining premium tax credits ... In its place the amendment would allow states to apply for waivers to 'encourage fair health insurance premiums.' ... On April 18, 2017, [CMS] released the Final HHS risk Adjustment Model Coefficients for 2018.... They include for the first time ... enrollment duration factors ... as well as a number of prescription drug factors[.]" (Timothy Jost, in Health Affairs)
Correcting Misconceptions About Invisible Risk-Sharing
"The Invisible Risk-Sharing Program (IRSP) will stabilize the individual insurance market and lower premiums while concurrently providing guaranteed access to coverage and protecting those with pre-existing conditions.... Is there enough money allocated? ... Is this program too complex for insurers? ... Is Maine a good example to predict a national outcome? ... Does the past experience of some prospective programs for small business tell us about future success in the individual market? ... How is this different from the ACA's reinsurance? ... Additional policies to consider." (Health Affairs)
The Effects of Ending ACA Cost-Sharing Reduction Payments
"There would be a significant amount of uncertainty for insurers in setting premiums to offset the cost of cost-sharing reductions.... Under a worst case scenario -- where only people eligible for sharing reductions enrolled in silver plans -- the required premium increase would be higher than 19%, and many insurers might request bigger rate hikes." (Henry J. Kaiser Family Foundation)
Steps Toward a More Sustainable Individual Health Insurance Market (PDF)
"Continued uncertainty could lead to additional insurers exiting the market, leaving consumers with fewer insurance choices -- or none at all. Improving the market would entail policymakers funding cost-sharing reduction (CSR) reimbursements, enforcing the individual mandate, directing external funding to offset premiums, and avoiding destabilizing action." (American Academy of Actuaries)
[Opinion] Health Insurance: Is It Time to Reset?
"[T]he fundamentals of the private insurance market are changing. Notwithstanding the political noise about what constitutes accessible, affordable coverage, two trends stand out: [1] The core market, employers, is shrinking. [2] ... consumers are disenchanted with health insurance.... Provider-sponsored health insurance plans that are part of regional, fully integrated systems of health are likely the future for private insurance." (Paul Keckley)
[Opinion] Trump's Dealmaking Model Doesn't Fit Health Care Policy
"The partisan divide in health policy is grounded in deeply felt differences on both sides over policy and principle. It's hard to see Trump's approach to deal making working very often in health. This was why Trump couldn't force a deal with the Freedom Caucus to pass the American Health Care Act in the House; the bill was not conservative enough for the caucus, and in their eyes, it violated their principles and political promises they had made. It is also why using Obamacare's marketplace cost sharing subsidies as a bargaining chip to try to force the Democrats to the table is unlikely to work." (Drew Altman, Kaiser Family Foundation, via Axios)
Insurer Financial Performance in the Early Years of the ACA
"The individual market is where just 7% of the U.S. population gets their insurance (and thus also represents a small share of most health insurers' business), but the stability of the market and willingness of insurers to continue to participate is essential to the ACA's success.... This [article] looks at trends in insurer financial performance in the individual market over the past few years, finding that the market is showing signs of stabilizing." (Henry J. Kaiser Family Foundation)
[Opinion] Chamber Letter Encourages Congressional Action on Health Care Legislation
"The reimposition of the health insurance tax is already increasing premiums for individuals, small business and seniors. Individuals, families, and employers will bear 60% of the burden of the tax ... The lack of certainty regarding cost-sharing reduction (CSR) payments is threatening to destabilize the marketplace at the very moment that insurers are trying to price plans for 2018.... The 'Cadillac Tax' ... is already affecting the decisions and offerings of employers ... [as] businesses are now evaluating ways to reduce their health care coverage offerings for their employees." (U.S. Chamber of Commerce)
[Official Guidance] Text of IRS Notice 2017-28: Public Comment Invited on Recommendations for 2017-2018 Priority Guidance Plan (PDF)
"The Treasury Department's Office of Tax Policy and the [IRS] use the Priority Guidance Plan each year to identify and prioritize the tax issues that should be addressed through regulations, revenue rulings, revenue procedures, notices, and other published administrative guidance. The 2017-2018 Priority Guidance Plan will identify guidance projects that the Treasury Department and the Service intend to work on as priorities during the period from July 1, 2017, through June 30, 2018.... Please submit recommendations by June 1, 2017, for possible inclusion on the original 2017-2018 Priority Guidance Plan." (Internal Revenue Service [IRS])
How Would Sales of Health Insurance Across State Lines Affect Competition and Pricing? (PDF)
"The intent of permitting insurance companies to sell across state lines is to increase competition and reduce the costs of health insurance. There is a good possibility the most likely scenario will be to decrease competition and, without affecting the cost of health care, allow premium rates to increase faster than required by the rise in health care costs." (Lawrence Mitchell, FCA, FSA-R, MAAA)
White House Officials Push Revised Health Bill
"[Under] this [ACA] replacement, states could seek waivers from many of those mandates if they demonstrate that premiums would be lowered, the number of insured people would increase, or 'the public interest of the state' would be advanced. States could request an exemption from the rule intended to ensure that people with pre-existing conditions could not be charged prohibitive premiums -- but only if those states establish a high-risk insurance pool." (The New York Times; subscription may be required)
A New Attempt Emerges to Bridge GOP Divisions on AHCA
"The proposal would first 'Reinstate Essential Health Benefits as the federal standard.'.... [T]he amendment would maintain most of the ACA's market reforms ... Waivers that would allow states to permit health status underwriting could dramatically increase premiums for people with high cost conditions to unaffordable levels. High risk pools could reduce the cost of coverage, but would have to be adequately funded." (Timothy Jost, in Health Affairs)
Risk Corridor Suit Dismissed as Premature; Supreme Court Ends Challenge to 'Administrative Fix'
"On April 18, 2017, [a] federal court of claims judge ... dismissed ... one of approximately two dozen lawsuits now pending in the federal court of claims brought by insurers who have been denied the full payment they believe is due them under the [ACA's] risk corridor program for 2014 and 2015. Also, on April 17, the Supreme Court denied certiorari [in West Virginia's challenge to HHS'] 2013 'administrative fix,' which had allowed states to permit insurers to continue to offer ACA-noncompliant 'transitional' or 'grandmothered' health plans after December 2013[.]" (Timothy Jost, in Health Affairs)
[Guidance Overview] The Final Market Stabilization Rule: What's There, What's Not, and How It Might Work
"Although the rule addresses market stability, it nowhere mentions the two greatest current threats to the stability of the individual market. The first is the ongoing confusion as to whether Congress will appropriate, or the administration will continue to pay, the $7 billion to $9 billion in cost-sharing reduction (CSR) payments it owes to insurers ... The second threat to market stability not mentioned in the rule is the administration's mixed messages about enforcement of the individual responsibility requirement." (Timothy Jost, in Health Affairs)
[Opinion] Moving Toward a Fair Federal Tax Treatment of Health Insurance (PDF)
"The federal tax exclusion on [employer-provided health] insurance is the major policy-driven contributor to increased cost growth.... [It] drives over-insurance, and thus the excessive reliance on third-party payment for medical services." (The Heritage Foundation)
[Opinion] Addressing Pre-Existing Conditions and Encouraging Continuous Coverage
"Health insurance rules must be crafted in a way that encourages individuals not only to get, but also to maintain coverage. Obamacare destabilized the market by enabling (and even encouraging) individuals to pay for coverage only when they expected to incur claims. Policymakers should link the ban on exclusions for pre-existing conditions to a requirement of continuous coverage." (The Heritage Foundation)
Insurance Companies Meet with CMS Administrator, Push for ACA Payments
"Insurance executives, as well as the head of the trade group America's Health Insurance Plans, met with [CMS Administrator] Seema Verma ... Insurers have been pressuring administration officials and lawmakers to fund the ACA's cost-sharing reduction payments." (Morning Consult)
[Opinion] Myths vs. Facts on Employer-Sponsored Healthcare Coverage
"Approximately 178 million Americans, more than half the population, currently enjoy health benefits provided by their employer.... [The] argument that the employer-sponsored healthcare system is driving up the cost of care is not only absurd, but completely refuted by the facts." (Washington Examiner)
Congressional Efforts to Amend the ACA Stall: What's Next?
"Many speculate that tax reform legislation could repeal (or further delay) the 40 percent excise tax and might also include a cap on the amount of employer-sponsored coverage that an individual may exclude from income and payroll taxes. This tax exclusion is the single largest tax expenditure in the federal budget ... Unlike the 40 percent excise tax on high-cost plans, which would be paid by the plan sponsor, employees themselves would pay the income taxes owed on coverage that exceeds the cap." (Segal Consulting)
Repeal, Replace ... Revise: Your Guide to Market Stabilization
"The Trump administration's proposed rule aimed at stabilizing the health law's insurance marketplace could have rapid, dramatic effects on people who do not get insurance through work and buy it on the [ACA]'s exchanges.... The controversial proposal by [HHS] drew letters from nearly 4,000 organizations and individuals during an unusually short, 20-day public comment period that ended in early March. Consumer groups hate it, saying it would wreak havoc by making it harder to get coverage. But [some] experts ... say it's helpful for insurers, though more adjustments are necessary." (Kaiser Health News)
[Opinion] What Does 'Across State Lines' Really Mean?
"[A] suggestion: modify federal law to require that the coverage in any policy approved in any state, be available for purchase in every state. This would require the states abandon their monopolistic mandate regulations. It would bring the possibility of some premium relief to consumers in states that have the most mandates.... It would still allow the option of higher-coverage policies everywhere. But it would not require everyone have identical basic coverage -- as Obamacare does. It would not require any insurance company to build a new network anywhere so its policyholders could be in the service area." (InsureBlog)
Trump Threatens to Withhold Payments to Insurers to Press Democrats on Health Bill
"Mr. Trump said he was still considering what to do about the payments approved by his Democratic predecessor, President Barack Obama, which some Republicans contend are unconstitutional. Their abrupt disappearance could trigger an insurance meltdown that causes the collapse of the 2010 health law, forcing lawmakers to return to a bruising debate over its future." (The Wall Street Journal; subscription may be required)
Employers Overwhelmingly Opposed to Additional Taxes on Employer-Provided Health Coverage
"92 percent of responding employers are against any policy that would tax workers, their families, and employers on a portion of health plan premiums.... [M]ore than 177 million Americans receive health insurance through an employer, and employers pay more than $668 billion annually to insure their employees." (Wolters Kluwer Law & Business)
Summary of Individual Market Enrollment and ACA Subsidies
"While it is unknown if the ACA will be unchanged, amended, or repealed in the immediate future, data from the individual marketplace can be useful in informing future policy decisions. This data can enable stakeholders to better understand the population currently receiving assistance and the amount of assistance being provided." (Milliman)
How U.S. Health Care Became Big Business
"[Dr. Elizabeth Rosenthal's] new book, An American Sickness, examines the deeply rooted problems of the existing health-care system and also offers suggestions for a way forward. She notes that under the current system, it's far more lucrative to provide a lifetime of treatments than a cure. 'One expert in the book joked to me ... that if we relied on the current medical market to deal with polio, we would never have a polio vaccine,' Rosenthal says. 'Instead we would have iron lungs in seven colors with iPhone apps.' " (National Public Radio)
TIGTA Assessment of Efforts to Implement the Employer Shared Responsibility Provision (PDF)
43 pages. "As of October 28, 2016, the IRS had processed 439,201 Forms 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, and nearly 110 million Forms 1095-C, Employer-Provided Health Insurance Offer and Coverage. However, our review identified that some of the processes did not function as intended, which resulted in the IRS not having accurate and complete data for use in its compliance strategy to identify noncompliant employers potentially subject to the Employer Shared Responsibility Payment. In addition, due to system errors, the IRS was unable to process paper information returns timely and accurately.... Further, the criteria used to identify validation errors in the submissions did not always work as intended.... Finally, the development and implementation of key systems needed to identify noncompliant employers subject to an Employer Shared Responsibility Payment have been delayed, not initiated, or cancelled." (Treasury Inspector General for Tax Administration [TIGTA])
Tweaks to AHCA Potentially Revive ACA Repeal and Replace Efforts
"On April 6, 2017, the House Rules Committee ... voted 9-2 to adopt an amendment that creates a risk-sharing fund.... The Palmer/Schweikert amendment is a bit vague and the structure of it applies only to prospectively-identified eligible individuals, which arguably leaves insurers with tail risk for non-eligible high-costs cases. The risk-sharing program would run as a federal program for the first three years and then states would take over." (Holland & Knight)
Court Lacked Jurisdiction to Hear Failed CO-OP's Claim Under ACA's '3Rs' Program
"The U.S. District Court for the Southern District of Iowa did not have jurisdiction over claims against HHS brought by the liquidators of a failed insurance cooperative because their requested damages were purely monetary in nature and could be adequately addressed in the Court of Federal Claims." [Gerhart v. HHS, No. 16-151, (S.D. Iowa Mar. 16, 2017] (Wolters Kluwer)
No 'Death Spiral': Insurers May Soon Profit from Obamacare Plans
"[T]he demise of the individual insurance market seems greatly exaggerated, according to a new financial analysis ... by Standard & Poor's, [which] looked at the performance of many Blue Cross plans in nearly three dozen states ... It shows the insurers significantly reduced their losses last year, are likely to break even this year and that most could profit -- albeit some in the single-digits -- in 2018. The insurers cover more than five million people in the individual market." (The New York Times; subscription may be required)
[Opinion] Trump and the GOP Could Fix Obamacare, Not Repeal It
"Republicans are left to try to paper over their differences by tinkering with 'community rating,' 'high-risk pools' and other things they barely understand but now have suddenly assigned make-or-break political significance.... But what if a newly elected Republican president eager for a political victory were to utter the unutterable -- to declare that he is willing to acknowledge the right of all Americans to buy all the medical care they need for no more than 15 percent of household income? ... What could a self-styled dealmaker demand from Democrats in return?" (Steven Pearlstein. in The Washington Post; subscription may be required)
ACA: Potential Legislative and Administrative Actions (PDF)
12 presentation slides; topics include: [1] Repeal Without Replace Scenario; [2] 2017 Proposed Legislative Reforms; and [3] Administrative Actions. (Health Actuarial Task Force, American Academy of Actuaries)
House GOP Amends Health Care Bill to Address Premiums
"Under the plan, the costliest people in the health care system would still obtain insurance on the individual market, unlike in a traditional high-risk pool. This proposal would likely prevent premiums from skyrocketing because insurers would get federal help to cover their most expensive patients. But the amendment lacks specifics, including which medical conditions would be eligible for remittance or when the federal funds would be used." (Morning Consult)
Pence Presents New Healthcare Offer to Freedom Caucus
"Vice President Pence ... presented an idea at the Freedom Caucus meeting to allow states to choose to apply for waivers to repeal two Obamacare regulations ... [1] Obamacare's essential health benefits, which mandate which health services insurers must cover, and [2] 'community rating,' which prevents insurers from charging sick people higher premiums. Conservatives had previously called for the bill to repeal those regulations outright, but the deal now being discussed would give states a choice by allowing them to apply for a waiver from the federal government." (The Hill)
Invisible High-Risk Pools
"Maine also used a form of invisible risk pools when it began transitioning away from a strict community-rating/guaranteed issue requirements in 2011 ... This experiment illustrates that Republicans have numerous tools and states have many ways to experiment to make their insurance markets less dysfunctional.... The results in Maine were that young peoples' premiums fell by about $5,000, while those much older saw their premiums fall even more." (National Center for Policy Analysis Health Policy Blog)
[Guidance Overview] CRS Report: Resources for Frequently Asked Questions about the Affordable Care Act (PDF)
35 pages. "This report provides resources to help congressional staff respond to constituents' frequently asked questions about the law. The report lists selected resources regarding consumers, employers, and other stakeholders, with a focus on federal sources. It also lists CRS reports that summarize the ACA's provisions." [Report R43215, updated Apr. 3, 2017] (Congressional Research Service [CRS])
House Passes Bill to Protect Access to Stop-Loss Insurance by Self-Insured Health Plans
"The House [on April 5] passed the Self-Insurance Protection Act (H.R. 1304) ... by a bipartisan vote of 400 to 16.... The legislation would amend [ERISA], the Public Health Service Act, and the Internal Revenue Code to clarify that federal regulators cannot redefine stop-loss insurance as traditional health insurance." [Fact Sheet also available.] (Committee on Education and the Workforce, U.S. House of Representatives)
How Would Cross-State Insurance Sales Affect Costs and Coverage for Consumers?
"If insurers sold plans across state lines, bare-bones catastrophic plans with low premiums and high out-of-pocket costs are likely to proliferate. These plans tend to appeal to younger, healthier adults who expect to use few health care services.... With the remaining comprehensive plans attracting mostly sicker, costlier enrollees, premiums and out-of-pocket costs would increase sharply. RAND researchers estimate that average annual premiums overall could rise by as much as $2,500 a year if the ACA were repealed in full and cross-state sales were permitted." (The Commonwealth Fund)
[Opinion] Selling Health Insurance Across State Lines Doesn't Lower Costs or Improve Choice
"[The ACA] includes a provision ... whereby an insurer could establish itself in one state and sell health insurance to consumers in multiple other states without having to follow those states' laws and regulations.... In the absence of legislative action, there is nothing preventing HHS Secretary Tom Price from issuing the required regulations and working with states to develop standards for interstate sales. In fact, several states already allow cross-state sales.... To date, six states have enacted laws to allow cross-state sales: Georgia, Kentucky, Maine, Rhode Island, Washington, and Wyoming. Yet none of these states has had a single new insurer enter its market because of its law." (The Commonwealth Fund)
[Opinion] CBO Provides a Roadmap for Improving AHCA
"Rather than criticizing the agency for delivering bad news, policymakers should examine the analysis to identify provisions that should be modified in order to produce a more sustainable reform -- and to get a better assessment from CBO.... [1] Higher financial penalties for failure to maintain coverage ... [2] The 'no-premium' health insurance option and automatic enrollment ... [3] A compromise on Medicaid eligibility within a reformed program ... [4] Additional support for low-income households above medicaid eligibility." (Health Affairs)
[Opinion] A Four-Step Plan for Bipartisan Health Reform
"In four broad steps, each component of which -- by themselves -- would constitute solid improvements, we have an opportunity to move past partisan bickering and put our health care system on stronger footing. Step 1: Enhance the Individual Market ... Step 2: Rationalize the Employer Market ... Step 3: Embrace Medicaid ... Step 4: Don't Forget the Big Picture." (Billy Wynne, in Health Affairs)
Rand Paul Says New Obamacare Repeal Talk 'Helpful,' But Needs More Time
"Multiple reports surfaced Monday that the White House and conservatives are discussing a compromise to grant [HHS] Secretary Tom Price more authority to allow states to waive certain Obamacare regulations that conservatives want repealed. [Sen. Rand Paul (R-Ky.)], leaving a meeting with House Freedom Caucus members in his office, confirmed that such discussions are in the works, and he indicated he had a conversation along those lines on Sunday, when he golfed with President Trump." (The Hill)
Half of Americans Are Responsible for Only 3 Percent of Health Care Costs
"The top 1 percent of health-care spenders use more resources, collectively, than the bottom 75 percent ... [T]he bottom half of spenders all together rack up only about 3 percent of overall health care spending -- a pattern that hasn't budged for decades. This creates a fundamental inequality in the country's health spending that is the crux of the challenge policymakers face: They need a system that works for people who are ill, but is attractive to those who are healthy and spend little on health care." (The Washington Post; subscription may be required)
HHS to Continue Obamacare Payments to Insurers with Lawsuit Pending
"The precedent that the cost-sharing subdues would be funded while the lawsuit is being litigated remains the policy of the current administration, according to the official ... The statement could provide some clarity for insurers as they decide whether to offer plans next year on the Obamacare exchanges." (Morning Consult)
[Opinion] Propping Up Obamacare: CMS Proposes Market Stabilization Rules
"The proposed rule addresses the Obamacare death spiral through a number of fixes in the areas of open enrollment period, special enrollment period, nonpayment of premiums, network adequacy and actuarial value.... While the rule moves in the right direction, CMS should consider strengthening it with [certain additional] changes[.]" (National Center for Policy Analysis Health Policy Blog)
[Opinion] Accessing Care in Michigan Under the ACA
"Since the ACA's coverage expansions were implemented in 2014, consumers' reported access to care, cost concerns, and coverage satisfaction improved. And, contrary to some national rhetoric, those with Medicaid coverage experienced positive changes, as did those with individually purchased health insurance coverage." (Health Affairs)
The Next Obamacare Battleground: Subsidies for Out-of-Pocket Costs
"For many people ... the demise of cost-sharing subsidies could mean the end of coverage -- whether or not the ACA is fully repealed. Not only would some enrollees be unable to afford treatment, insurers likely would hike premiums or bolt from Obamacare exchanges and even the broader individual market ... In 2016 alone, the federal government paid about $7 billion to insurers to lower out-of-pocket expenses for qualified enrollees[.]" (Kaiser Health News)
Another Risk Corridor Claim Moves Forward
"The court declined to issue a stay of the proceedings because ... ' "the existence and status of other risk corridor cases should not impede Molina's ability to pursue relief.' No limitations were placed on the contents of the briefs, but the government was restricted to a fourteen-day extension to file a response 'due to the government's familiarity with the issues presented and the ample size of the legal staff devoted to these cases.' " [Molina Healthcare of Calif., Inc. v. U.S., No. 17-97C (Cl. Ct. Mar. 24, 2017)] (Wolters Kluwer)
[Guidance Overview] Major ACA Changes for Employers Still Possible This Year: An In-Depth Look at What's at Stake (PDF)
"[It] is possible that Congress will pass bipartisan legislation this year that revises certain aspects of the ACA, including the Cadillac Tax and employer mandate ... Regardless of any legislative action by Congress, however, the federal agencies with enforcement authority over the current ACA rules can issue, revise, or withdraw regulatory and sub-regulatory guidance regarding certain aspects of the ACA, including those that impact [group health plans] and employer-sponsors. Further, the outcome of House v. Price, a pending federal court case that challenges [HHS] use of federal funds to pay for cost-sharing reduction (CSR) subsidies on the public health insurance exchanges, could have a significant impact on the individual insurance market, forcing Congress to reopen debate about ACA-related legislation." (Trucker Huss)
[Opinion] The Economic Effects of Repealing the Job Killing Provisions of Obamacare (PDF)
13 presentation slides. "Repealing the ACA would, by 2026: [1] Increase real GDP by $393 billion, or 1.97%. [2] Increase private sector employment by 874,000, or 0.49%. [3] Increase personal income by $174 billion, or 0.76%. [4] Have reduced federal revenue cumulatively by $692 billion, or 1.60%." (National Center for Policy Analysis [NCPA])
Strike One on Health Care Reform: Where Do We Go from Here?
"There are conflicting reports on the status of health care reform ... Extreme measures have been proposed, including repealing the ACA in its entirety without seeking a replacement. More moderate options also have been proposed, and there are seventy pending bills that already have been proposed in the current Congressional session. Others have suggested that a bipartisan measure ultimately may have the best chance of becoming law." (Cadwalader, Wickersham & Taft LLP)
[Opinion] The Trump Administration Needs to Decide if They Are In or Out
"Right now, there are two key questions the Trump administration has to answer: [1] Will they pull the plug on the low-income cost sharing subsidies? If they do, the cost to the health plans would be about $8 million a month for every 100,000 cost sharing people they cover. [2] Are they going to enforce the individual mandate or not? ... The individual mandate was never terribly effective, but it did get people's attention. Putting the word out that you don't have to sign up until you are sick would about finish things off." (Bob Laszewski's Health Care Policy and Marketplace Review)
Senate Committee Confirms Secretary of Labor Nominee
"R. Alexander Acosta was confirmed as Secretary of Labor by the Senate Health, Education, Labor and Pensions Committee on [March 30]. The committee voted 12-11 along party lines; a full Senate vote is expected soon." (Pensions & Investments)
Almost Half of Doctors Support a Single-Payer Healthcare System
"48% of the 500 doctors who responded said they would support a single-payer system that would provide healthcare insurance to everyone ... Doctors said the current fragmented system is a barrier for patients who either don't have health insurance or can't find a doctor who accepts their coverage[.]" (FierceHealthcare)
Bill Aims to Offer ACA Exchange Relief
"The bill would allow people with no options to buy insurance with their ACA subsidies outside of the exchanges, as long as they purchase a plan that's been approved by their state for sale in the individual market. The program would be available to people living in counties that [HHS] has certified to have no exchange plans available." (FierceHealthcare)
House Overwhelmingly Votes to Repeal Antitrust Exemption for Health Insurers
"The bill would amend the McCarran-Ferguson Act, which has granted a limited, but important, antitrust exemption to insurers for the last 70 years. This repeal measure reflects a heightened concern by the House of Representatives about high concentration and potential anticompetitive conduct in the health insurance industry, and could be used to fill the gap in states with weak antitrust or consumer protection laws. Following the overwhelming 416-7 House vote, the bill will now go to the Senate." (Pepper Hamilton LLP)
[Opinion] High-Risk Pools for People with Preexisting Conditions
"[H]igh rates of uninsurance and lack of affordability for all buyers in the individual market existed before the ACA, even in states with high-risk pools.... [P]olicymakers seem to substantially underestimate the number of Americans with preexisting conditions who might be forced to purchase coverage through a high-risk pool if insurers are allowed to deny coverage in the marketplace." (The Commonwealth Fund)
Risk Adjustment, Reinsurance Improved Financial Outcomes for Individual Market Insurers with the Highest Claims (PDF)
10 pages. "[The authors] compared revenues to claims costs for insurers in the individual market during the first two years of ACA implementation (2014 and 2015), before and after the inclusion of risk adjustment and reinsurance payments. Before these payments were included, for the 30 percent of insurers with the highest claims costs, claims (not including administrative expenses) exceeded premium revenues by $90-$397 per enrollee per month. The effect was reversed after these payments were included, with revenues exceeding claims costs by $0-$49 per month." (Health Affairs)
Justice Department Joins Lawsuit Alleging Massive Medicare Fraud by UnitedHealth
"The Justice Department has joined a California whistleblower's lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans.... [The whistleblower] has accused the insurer of 'gaming' the Medicare Advantage payment system by 'making patients look sicker than they are' said his attorney ... [The attorney] said the combined cases could prove to be among the 'larger frauds' ever against Medicare, with damages that he speculates could top $1 billion." (Kaiser Health News)
Insurers Struggle to Plan for Future Amid Health Care Policy Vacuum
"Insurers are most concerned about how the administration and Republicans in Congress plan to treat the ACA's cost-sharing reduction payments, which help subsidize out-of-pocket payments for lower-income enrollees, and whether the Trump administration will enforce the ACA's individual mandate ... Insurers should have until June or July to file their rate requests, an extended timeframe proposed last month by [CMS]. Those requests will offer the first insights into how much they hope to charge consumers for different plans next year." (Morning Consult)
ACA Repeal Is Back on the Agenda, Republicans Say
"House Republican leaders and the White House ... have restarted negotiations on legislation to repeal the [ACA] ... [House Speaker Paul Ryan] declined to say what might be in the next version of the Republicans' repeal bill, nor would he sketch any schedule for action. But he said Congress needed to act because insurers were developing the premiums and benefit packages for health plans they would offer in 2018, with review by federal and state officials beginning soon." (The New York Times; subscription may be required)

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