Bernard DiFiore's blog

PPACA Fails to Simplify Administrative Process

The Patient Protection and Affordable Care Act (PPACA) is failing to live up to a key promise that was made when the law was enacted in 2010 —simplifying the administrative process to obtain health insurance coverage through a state health benefits Exchange.

The U.S. Department of Health and Human Services (HHS) recently issued a draft of the paper application and a 60-page description of the online version earlier this week. While the White House has supported the law, claiming Exchanges, or “marketplaces,” will “help you find health insurance that fits your budget, with less hassle,” it is becoming increasingly clear that is not the case.

Funding for Navigator Program Hits Roadblock: Opens Door for Reliance on Existing Broker System

A senior health care official with the Obama Administration recently said the funding for navigator programs may not be forthcoming based on legal requirements embedded in the Patient Protection and Affordable Care Act (PPACA), according to 

Contract Award Puts Wheels in Motion for Establishing Federal Insurance Exchange Program

In an effort to provide consumers with competitive insurance options as mandated by the Patient Protection and Affordable Care Act (PPACA), the federal government has awarded a $93.7 million, multi-year contract to CGI Federal, Inc. to establish a federal health insurance exchange. The Centers for Medicaid & Medicaid Services (CMS) Center for Consumer  Information & Insurance Oversight (CCIIO) has hired CGI Federal, Inc., a U.S.  subsidiary of CGI Group, Inc., to build the federally-sponsored health insurance marketplace that will “provide millions of Americans with ‘one-stop shopping’ for affordable coverage,” according to the CCIIO website. The CGI Group, Inc.

U.S. Congressional House Subcommittee Holds Hearing on Medical Loss Ratios – Concerns Expressed about Broker Role

Last Thursday, the U.S. House of Representatives Small Business Subcommittee on Investigations, Oversight and Regulations held a hearing on the issue of the Medical Loss Ratio (MLR) in Washington, D.C. Titled “New Medical Loss Ratios: Increasing Health Care Value or Just Eliminating Jobs?,” the hearing was a forum for views on how the MLRs mandated by the Patient Protection and Affordable Care Act (PPACA) could impact the health care insurance industry. Most individuals testifying expressed concerns about how the MLR formula as currently structured could greatly hinder the ability of brokers and agents to support consumers and business owners when purchasing health insurance.

States Given Responsibility of Defining Essential Benefits

In a press release issued today (December 16, 2011), the U.S. Department of Health and Human Services has announced that state exchanges will now determine their benchmark for essential benefits based upon use of the most popular plans in their region and the ten benefit categories of care that were originally defined in the health care reform regulations. This change to move the responsibility of essential benefits to the state level will give states the flexibility to match their exchange plans to be equal to those offered by a typical employer in the state. Further, those states that have a broader based health care coverage mandate will not be penalized for incorporating their states mandates into their definition of essential benefits.

HHS Announces Medical Loss Ratio Rule

The Department of Health and Human Services (HHS) just released its final Medical Loss Ratio rule, and the outcome does not bode well for the broker/agent community. In the ruling HHS has rejected the NAIC recommendation to exclude broker/agent fees from insurance companies’ allowed administrative costs.

Under the rule beginning this year, individual and small group market insurance plans will be required to spend 80% of the premiums on medical care and health care improvement. Only the remaining 20% will be allowed towards administrative costs. Much the same, large group plans will have an 85% of premium requirement.

Brokers are Key to Successful Implementation of Health Benefits Tax Credits

One of the more positive aspects of the Patient Protection and Affordable Care Act (PPACA) was the authorization of a federal tax credit for small business owners who offer health insurance benefits to their employees. This tax credit potentially is worth a great deal of money to small business employers. Despite the potential for significant cost savings, efforts to promote the Small Business Health Care Tax Credit to small businesses have missed the mark.

U.S. Supreme Court Likely to Review Legality of PPACA

Sometime next year, it is highly probable the U.S. Supreme Court will decide whether the federal government can force people to buy health insurance or pay a fine.

In addition to the landmark impact this ruling will have on the health care industry specifically, it also could sway the outcome of the 2012 elections -- from the Oval Office to other key legislative positions around the country. No matter what, the stakes are high. Even if the issue escapes scrutiny by the Supreme Court in 2012, it’s possible that when the Justices do address the merits of the case that a Republican administration will be in the White House – along with a Justice Department that no longer will defend the Patient Protection and Affordable Care Act (PPACA).

PPACA Implementation Continues: Experts Assess Impact on Employer-Sponsored Insurance Coverage

In a recent post, we discussed how challenging it can be for consumers to grasp the many changes to health insurance under the Patient Protection and Affordable Care Act (PPACA). Employers also face many of the same challenges, but with the added mandate to comply with new federal and state requirements as an outgrowth of health care reform initiatives being implemented in a struggling U.S. economy.   

Some of the key questions public policymakers are asking include:

Insurance Regulators Tout Strength of State-Based Insurance and Financial Regulation on Capitol Hill

With all the focus at the federal level on health care reform and budget spending shortfalls, a recent congressional hearing reminds us of the importance of state-based insurance regulation.[1] The hearing focused on several financial technical provisions that don’t always impact brokers directly.  However, an indirect relationship exists between the stability of health insurance offerings and the financial systems used to support and underwrite those offerings.