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<< Older News  |  September 24, 2021


All News > Health Plan Policy

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Democrats' Stumble on Drug Prices Shows Power of Industry
The New York Times; subscription may be required Link to more items from this source
Sept. 16, 2021

"The dynamic is familiar to lawmakers who have worked on health issues: Health industries are large and powerful lobbies, and they do not enjoy having their revenues cut. As with measures that might reduce payments to hospitals, doctors and insurance companies, the House's attempt to take a bite out of drug companies has generated a backlash."

Tags: Health Plan Policy  •  Prescription Drug Costs

Why the Flawed Hospital Price Transparency Requirements Miss the Mark
BenefitsPro; free registration required Link to more items from this source
Sept. 16, 2021

"[The hospital price transparency] requirements ... at least in [their] current form, will not drive significant transformation.... Here's why: [1] Current pricing and payment processes lack clarity. [2] Very few fully comply with the HPT and have no incentive to do so. [3] Transparency in some markets may actually drive prices up, not down. [4] About 20% of consumers of health care still account for 80% of the health care spend."

Tags: Health Plan Costs  •  Health Plan Policy

ACA Litigation Still on the Docket After California v. Texas
Congressional Research Service [CRS] Link to more items from this source
Sept. 15, 2021

"Referred to as 'the most challenged statute in American history' by some commentators, the [ACA] has been the subject of numerous lawsuits since its enactment in 2010 ... This Legal Sidebar provides relevant background on private health insurance requirements in Title I of the ACA, discusses several notable past or pending ACA cases, and concludes with select legal considerations for Congress." [LSB10641, Sep. 14, 2021]

Tags: Health Plan Policy

No Surprises Act: Latest Proposed Regs Focus on Data Collection and Enforcement
Health Affairs Blog Link to more items from this source
[Guidance Overview]
Sept. 14, 2021

"The proposed rule focuses on [1] the submission of information about air ambulance services by air ambulance providers, group health plans, insurers, and Federal Employee Health Benefits (FEHB) carriers; [2] the process that HHS will take to investigate and enforce violations of federal insurance law; and [3] implementation of a CAA provision that requires insurers to disclose the amount they pay in direct and indirect compensation to agents and brokers for enrollment in individual market coverage and short-term, limited duration insurance (STLDI)."

Tags: Health Plan Administration  •  Health Plan Policy

'Uninsured Rate' Measurements and Health Policy Considerations
Society of Actuaries Link to more items from this source
Sept. 14, 2021

29 pages. "While different measurement techniques are applied, directional changes in uninsured rate calculations are often used as a primary source to gauge the impact of ACA policy, the administrative management of the program, and the impact of subsequent regulations. Consequently, appropriate comprehension of the uninsured rate is an important measure as it shapes the direction of future policy."

Tags: Health Plan Policy

Employers Considering Health Strategy Changes
National Alliance of Healthcare Purchaser Coalitions Link to more items from this source
Sept. 13, 2021

"Employers continue to have significant concerns about the affordability of employer-provided health coverage for employees and their families ... Most employers view potential health reforms favorably overall ... Employers viewed a public option most favorably if pricing is available to all plan sponsors[.]"

Tags: Coronavirus (COVID-19)  •  Health Plan Costs  •  Health Plan Design  •  Health Plan Policy

House Democrats Reveal Health, Paid Leave Policies in Budget Package
Mercer Link to more items from this source
Sept. 13, 2021

"Draft bills to add new benefits to Medicare, create a government-run paid family and medical leave benefit for US workers, and boost penalties for mental health parity violations were unveiled ... by key House committees.... A major concern for employers is whether [any proposal to] let the government negotiate drug prices will extend those negotiated prices to private plans."

Tags: Health Plan Design  •  Health Plan Policy  •  Medicare  •  Prescription Drug Costs

Treasury Department 2021-2022 Priority Guidance Plan (PDF)
Internal Revenue Service [IRS], U.S. Department of the Treasury Link to more items from this source
[Official Guidance]
Sept. 10, 2021

"The 2021-2022 Priority Guidance Plan contains 193 guidance projects that are priorities for allocating Treasury Department and Service resources during the 12-month period from July 1, 2021 through June 30, 2022 (the plan year)." [Employee benefit items begin on page 3, including 19 retirement plan items and 16 items relating to executive compensation, employment taxes, health care and other benefits.]

Tags: Executive comp  •  Health Plan Policy  •  Retirement Plan Policy

Editor's Pick Ways and Means Budget Reconciliation Bill: Summary and Analysis of Paid Leave and Retirement Provisions
Brownstein Hyatt Farber Schreck LLP Link to more items from this source
Sept. 10, 2021

"On Tuesday, Sept. 7, House Ways and Means Committee Chair Richard Neal (D-MA) released part of the committee's portion ... [of] the expected $3.5 trillion budget reconciliation measure ... This alert summarizes Subtitles A (Universal Paid Family and Medical Leave) and Subtitle B (Retirement)."

Tags: Health Plan Policy  •  Retirement Plan Policy

Coverage and Cost Effects Insurance Reforms Under Consideration by Congress
The Commonwealth Fund Link to more items from this source
Sept. 9, 2021

"Making ARPA premium subsidies permanent and filling the Medicaid coverage gap would reduce the number of people without insurance by nearly one-quarter, or 7.0 million people, in 2022. All states would see a drop in their uninsured population ... Enrollment in subsidized marketplace plans would nearly double, while premiums would fall by 18 percent on average. Federal spending would increase by an estimated $442 billion over 10 years[.]"

Tags: Health Plan Policy

Payers, Providers Seek Leeway on Surprise Medical Bill Ban Going Into Effect in 2022
FierceHealthcare Link to more items from this source
Sept. 9, 2021

"Providers believe that new requirements for notices of impending out-of-network charges and estimates on costs could provide a major administrative burden, according to comments on a regulation that outlines the protections. Payers, meanwhile, say they will need more time to implement parts of the rule and want a safe harbor from any inadvertent penalties."

Tags: Health Plan Administration  •  Health Plan Policy

Seventh Circuit: ERISA Does Not Cover Charter School Teachers
DeBofsky Sherman Casciari Reynolds P.C. Link to more items from this source
Sept. 2, 2021

"[T]he court discussed the nature of charter schools and what distinguishes them from purely private schools, which led the court to find: '[A] charter school in Illinois is part of the set of public educational offerings, which makes it appropriate to conclude that the school district may include charter-school teachers in its pension and welfare plans without losing its exemption under ERISA.' " [Graham v. Board of Ed. of City of Chicago, No. 19-2745 (7th Cir. Aug. 10, 2021)]

Tags: ERISA Preemption  •  Health Plan Policy  •  Retirement Plan Policy

The ACA After a Decade: Industrial Organization of the Insurance Exchanges
National Bureau of Economic Research [NBER]; purchase required for full document Link to more items from this source
Aug. 30, 2021

"[The authors] revisit the inherent market failures in health care markets that necessitate key ACA exchange regulations and investigate whether they have succeeded in their goals of expanding coverage, creating robust marketplaces, providing product variety, and generating innovation in health care delivery. [They also] discuss empirical IO research to date and also highlight shortcomings in the existing research that can be addressed moving forward [and] conclude with a discussion of IO research-based policy lessons for the ACA exchanges and, more generally, for managed competition of private insurance in health care."

Tags: Health Plan Design  •  Health Plan Policy

ERISA Advisory Council to Meet September 30
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL] Link to more items from this source
[Official Guidance]
Aug. 30, 2021

"[T]he 208th open meeting of [the ERISA Advisory Council] will be held via a teleconference on Thursday, September 30, 2021.... The purpose of the open meeting is for the members of the ERISA Advisory Council to discuss potential recommendations for the Secretary of Labor on the issues of: [1] Gaps in Retirement Savings Based on Race, Ethnicity and Gender, and [2] Understanding Brokerage Windows in Self-Directed Retirement Plans."

Tags: Health Plan Policy  •  Retirement Plan Policy

U.S. Chamber of Commerce Files Lawsuit Challenging HHS's Health Plan Price Transparency Rule
Troutman Sanders Link to more items from this source
Aug. 26, 2021

"The Chamber seeks declaratory and injunctive relief arguing that the regulation 'runs afoul of long-established protections against the forced disclosure of confidential commercial information, including trade secrets, and is detrimental to the business community as a whole.' " [Chamber of Commerce of U.S. v. HHS, No. 21-309 (E.D. Tex. complaint filed Aug. 10, 2021)]

Tags: Health Plan Administration  •  Health Plan Costs  •  Health Plan Policy

How Biden's Executive Order on Promoting Competition May Impact Health Insurance
Corporate Synergies Link to more items from this source
Aug. 24, 2021

"The Order includes renewed proposals for importing prescription drugs and increased support for generic and biosimilar drugs, which can provide low-cost options for patients.... This Order makes it clear that the FTC and Department of Justice will have considerable oversight and enforcement power to stop mergers of, and potentially break up, large health insurance carriers, healthcare providers and pharmaceutical companies[.]"

Tags: Health Plan Design  •  Health Plan Policy

The Uninsurance Rate Held Steady During the Pandemic as Public Coverage Increased
Robert Wood Johnson Foundation Link to more items from this source
Aug. 24, 2021

"Between March 2019 and April 2021, the share of nonelderly adults reporting employer-sponsored insurance declined from 65.0 percent to 62.3 percent, a decrease of approximately 5.5 million adults. Over the same period, the share reporting public coverage increased from 13.6 percent to 17.5 percent, an increase of approximately 7.9 million adults. The national uninsurance rate held steady at approximately 11 percent."

Tags: Coronavirus (COVID-19)  •  Health Plan Policy

Three Steps to Achieving More Affordable Health Insurance in the Individual Market
Health Affairs Blog Link to more items from this source
Aug. 19, 2021

"In this post, [the author explains] how ACA policies inflated premiums while failing to provide an efficient way to expand coverage, and [proposes] three steps to create a more affordable, competitive, and efficient individual market for people of all incomes.... [1] Fixed premium subsidies.... [2] A federal reinsurance program.... [3] Codification of individual coverage health reimbursement arrangements."

Tags: Health Plan Design  •  Health Plan Policy

What a Difference Discretion Makes
Kantor & Kantor Link to more items from this source
Aug. 19, 2021

"The appellate court explained that the California statute could be read to apply if a policy covered even one California resident, even if the claimant was not a California resident himself. However, the Court concluded that such an interpretation would violate the Commerce Clause and thus be unconstitutional. [That] interpretation would also be a logistical nightmare since the standard of review in any one case would depend on the residence of all the other plan participants.' [Mayer v. Ringler Assocs. Inc., No. 20-1281 (2d Cir. Aug. 12, 2021)]

Tags: ERISA Preemption  •  Health Plan Administration  •  Health Plan Policy

AHA Presses for Meeting with Federal Agencies as Scrutiny of Hospital Deals Ramps Up
FierceHealthcare Link to more items from this source
Aug. 19, 2021

"The American Hospital Association (AHA) wants to make its case to the Biden administration that hospital mergers are not negatively impacting prices or quality ... The hospital advocacy group wrote a letter Wednesday to the leaders of [HHS, DOJ and the FTC] offering updated industry-funded studies on the impact of mergers. The letter comes more than a month after President Joe Biden signed an executive order calling for the DOJ and the FTC to review merger guidelines for hospitals."

Tags: Health Plan Policy

Employer Self-Funded Health Insurance Is Taking Us in the Wrong Direction
Alain C. Enthoven, in Health Affairs Blog Link to more items from this source
Aug. 13, 2021

"Self-funded arrangements have grown steadily as a share of the insurance market over the past 15 years and now include many employers with less than 200 employees. While this may be the most cost-effective decision for individual employers under the current regulatory framework, it has the effect of locking in uncoordinated, open-ended fee-for-service (FFS) and locking out comparatively economical Integrated Delivery Systems (IDS)."

Tags: Health Plan Design  •  Health Plan Policy

United Behavioral Health, United Healthcare Insurance Co. Plans to Pay $15.6M, Take Corrective Actions After Federal, State Investigations
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL] Link to more items from this source
Aug. 12, 2021

"An investigation by the department's Employee Benefits Security Administration found that -- going back to at least 2013 -- United reduced reimbursement rates for out-of-network mental health services, thereby overcharging participants for those services, and flagged participants undergoing mental health treatments for a utilization review, resulting in many denials of payment for those services." [Walsh v. United Behavioral Health and UnitedHealthcare Ins. Co., No. 21-4519 (E.D.N.Y. settlement agreement filed Aug. 11, 2021); Walsh v. UnitedHealth Group Inc. and Oxford Health Ins. Inc., No. 21-4519 (E.D.N.Y. settlement agreement filed Aug. 11, 2021)] 

Tags: Health Plan Administration  •  Health Plan Design  •  Health Plan Policy

Text of EBSA Request for Nominations: Advisory Council on Employee Welfare and Pension Benefit Plans
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL] Link to more items from this source
[Official Guidance]
Aug. 5, 2021

"The terms of five Council members expire at the end of this year. The groups or fields they represent are as follows: [1] Employee organizations; [2] employers; [3] the general public; [4] actuarial counseling; and [5] investment counseling.... Nominations must be received on or before [45 days after publication of this notice in the Federal Register, scheduled for Aug. 6, 2021]."

Tags: Health Plan Policy  •  Retirement Plan Policy

Comments on the Development of a Public Health Insurance Option (PDF)
The Brookings Institution Link to more items from this source
Aug. 3, 2021

"In principle, a public option could offer lower premiums without paying providers less by having lower administrative costs or setting premiums that do not incorporate a profit margin. In practice, however, these cost advantages would likely be more than offset by a public option's disadvantages in utilization management, risk selection, and risk adjustment diagnosis coding.... Reducing provider prices would, of course, involve tradeoffs."

Tags: Health Plan Design  •  Health Plan Policy

Health Insurance Coverage Among Working-Age Adults with Disabilities: 2010-2018
Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS] Link to more items from this source
Aug. 2, 2021

"From 2010-11 to 2017-18, the proportion of U.S. adults with disabilities who lacked health insurance coverage for a full year was nearly halved, falling by about 46% from 17% to 9%. There was also an increase of about 14% in the proportion of adults with disabilities who had continuous coverage, from about 71% to 81%. These improvements were concentrated immediately after 2014, when the largest ACA-driven insurance expansions first took effect."

Tags: Health Plan Policy

<< Older News  |  September 24, 2021

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