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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."

CMS Issues Guidance on Role of Agents and Brokers in Health Exchanges

"Agents and brokers will be able to assist consumers either through an insurer-based pathway, in which the agent or broker uses an insurer's website to assist consumers, or directly through the exchange website.... Web brokers are potentially problematic because they resemble and may be seen as a substitute for the exchange website itself. ... Unlike traditional brokers and agents, web brokers must display all QHPs, regardless of appointment or compensation arrangements. If a consumer wishes to enroll in a plan for which the web broker does not have an appointment, the web broker must direct the consumer to the exchange website for enrollment."

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."

Implementing Health Reform: Proposed Regs for Exchange 'Navigators'

"The navigator program has become surprisingly controversial. Insurance agents and brokers have seen it as threatening their territory. Agents seem to be concerned that if navigators help consumers enroll in health insurance plans, agents will lose the commissions to which they are entitled when they themselves market insurance products.... Responding to lobbying by politically powerful agent organizations, states that have shown little interest in participating in any way in the implementation of the ACA have been enacting legislation to regulate the navigator program. Many of these states will have federal exchanges. The proposed regulations lay down standards for the navigator program in the federal exchange which will preempt more restrictive state standards. It also clarifies the extent to which states can license navigators in both the state and federal exchanges."

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."

HHS Letter to Health Insurers Describes Rate Reviews, 'Meaningful Difference' Requirement

"Much of the information in this guidance can be found in already-released regulations or guidances, but the level of operational detail found in this letter -- including in particular implementation timelines -- is unprecedented. It is perhaps the clearest sign to date that the FFE is in fact going to happen, and will arrive on time."

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."

Analyzing the January 2014 Health Exchange Enrollment Report

"Ultimately, the goal of the ACA is to reduce the number of the uninsured, but this can happen by enrolling individuals who would otherwise have become uninsured as well as enrolling individuals who are currently uninsured. The January report does not tell us how many enrollees fit in each category. But a Gallup poll released on February 12 found that the rate of uninsured in the U.S. had dropped sharply from 17.1 in the fourth quarter of 2013 to 16 percent in the first quarter of 2014, while the rate of uninsured 26- to 34-year olds dropped from 30.2 to 25.7 percent."

Aspects of Healthcare Reform: The Individual Market; Mental Health and Substance Abuse Parity

"[It] seems that insurers have set their rates based on projections that the 2014 risk pool is going to be pretty expensive, and that state regulators have allowed them to do so.... [T]he proposed solutions may simply make matters worse... The basic rule is that where plans or issuers offer mental health or substance use disorder benefits in one of six classifications, they cannot impose financial requirements or quantitative treatment limitations on those benefits that are more restrictive than the predominant requirements or limitations that apply to substantially all medical surgical benefits in the same classification.... Plans or issuers are required to perform the parity analysis annually in years when a change in benefit design, cost-sharing structure, or utilization affects the analysis within a classification."