Search the News Archive

Another Association Health Plan Success Story

"Rates for ACA plans require merely a list of employees, their ages, sex and marital status, and the nature and location of the business. No medical info is necessary. So groups with 3 employees on chemo and 4 on dialysis pay the exact same rate as those with relatively healthy employees.... AHP plans require medical histories, current meds and the like, and thus the process requires more effort ... But healthier groups can benefit greatly[.]"

Prediction: Congress Won't Whack the Cadillac

"In this installment of Congressional drama the supermajority will ... [say] that they can't kill the tax without offsetting revenues. They will again claim to be good stewards of our tax dollars and voice how much they dislike the tax. But when the dust has settled the Cadillac Tax will live."

Thoughts On Risk Adjustment

"[T]he Trump Administration has temporarily suspended all payments and collections of RA until the lawsuit is resolved.... [T]his is something that could have been avoided and fixed by the prior administration.... They could have issued interim rules to circumvent the problem. They could have adjusted the 2017 Notice of Benefit and Payment Parameters that were rushed through in late 2016 to mitigate the problem too. But they didn't."

And the HIT Just Keeps on Coming

"The [Health Insurance Tax, an ACA-imposed tax on fully insured health plans,] is non-deductible, meaning for every $1.00 in taxes the insurer will need to take in $1.54 (assumes 35% corporate tax rate). For 2018, the amount this tax must generate is $14.3 billion -- meaning insurers must generate $22 billion of additional premiums to pay for it.... To offer transparency, many insurers are breaking out these taxes on renewals for consumers to see. But, for most employer plans -- where a large amount of this revenue is generated -- this tax isn't transparent to employees."

A Carrier's Economist's Take on the ACA

"Between 2010 and the actual ACA launch, [one Blue Cross plan] spent over $100,000,000 in new spending just on compliance work and building the systems to allow us to participate. This is money that could have bought actual health care. Pre-ACA we served an individual market with the following characteristics: 125,000 people, Average age 36 years, 51% female ... Fast forward to 2017: 165,000 people, Average age 46 years old [... 30% increase; older,sicker], 58% female [... more expensive claims] ... Only 40% of policyholders keep their plan for 12 premium payments in a row."

Four Reasons Why the CBO's AHCA Score Is Flawed

"[1] CBO is assuming 4 million more people starting out with insurance than the actual number.... [2] AHCA's CBO score includes the potential enrollment from the 19 states that 'could' expand their Medicaid rules.... [3] While CBO doesn't actually define what constitutes insurance in the score, they insinuate that some states will cut or reduce the number of essential health benefits and cause out-of-pocket limits to rise. Suffice it to say it's amazing that they can't give us this definition yet count a few million people as uninsured because of this definition.... [4] Finally, the CBO score doesn't tell us who doesn't want to buy insurance. Without a mandate any number of people might simply say no thanks. These people aren't losing insurance, they simply don't want it."

SHOP's a Flop

"The SHOP Exchange was created to provide employers with less than 50 employees an easy to use process to enroll employees in group health insurance.... Turns out SHOP enrollment is extremely cumbersome, there are less plan options compared to the off exchange market, and that tax credit, well it hasn't been worthwhile for most employers. Plus it's only available for a maximum of two years.... Less than 3% of projected enrollment. That is why SHOP should be dropped."

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."

Don't Get Too Excited, Pinal County

"News broke of Blue Cross Blue Shield of Arizona remaining in the marketplace in Pinal County, Arizona late on Wednesday. Obamacare supporters will rejoice with a thunderous round of applause to the insurance company and positive vibes about how tax credits will keep costs low. But the folks in Pinal County have little to get excited about.... In their announcement to remain in the marketplace, their Senior VP of sales, strategy and marketing, Jeff Stelnik, said premiums will increase by 51%."

Is Medical Mutual of Ohio Losing or Winning?

"Limiting network choice and limiting where to do business is bound to reduce the unhealthy risk while also eliminating providers who are unwilling to lower their reimbursement rates. Instead of Medical Mutual rolling out 45% increases to members they will send them cancellation notices.... Obamacare supporters will point to the rate reductions as a product of the law working. Never mind the fact that it is only 'working' by limiting the providers of care that are essential to the health of those Obamacare was supposed to protect the most."