Individual

HHS Issues Update on PPACA’s Pre-Existing Condition Insurance Plan (PCIP) Program

The Department of Health and Human Services (HHS) recently issued an update highlighting state involvement with the Pre-Existing Condition Insurance Plan (PCIP) Program.  The purpose of the PCIP Program is to make health insurance available to individuals who have been denied coverage by insurance companies because of a pre-existing condition. 

Author: Michael Gomes

PPACA Reaches Second Anniversary Milestone Today: Celebration Short-Lived as U.S. Supreme Court Hears Oral Arguments Next Week

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. PPACA promised to provide high quality health insurance for all Americans. Whether this goal is being met today – or will be met in the future– remains questionable, especially in light of the upcoming challenges PPACA faces including the U.S. Supreme Court review and the need to fund many of the new programs.

Author: Michael Gomes

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.

Author: Bernard DiFiore

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.

Author: Bernard DiFiore

HHS Publishes Proposed Rule on Exchange-Based Risk Adjustments

With on-going implementation of the Patient Protection and Affordable Care Act (PPACA), actuaries and other experts have expressed concerns about how the new state-based insurance exchanges, which are geared to the small group and individual markets with dedicated subsidizes, could distort the broader health insurance market. For example, what if insurance carriers place the burden of individuals with higher health risks on qualified health plans (QHPs) participating in the insurance exchanges and keep the better risks outside of the exchanges?

Author: Michael Gomes

Eleventh Circuit Court of Appeals Rules PPACA's Mandate to Buy Health Insurance Unconstitutional: Decision Leads to a Split in Federal Appellate Courts

A recent ruling by the U.S. Court of Appeals for the Eleventh Circuit has declared the ‘individual mandate’ to purchase health insurance unconstitutional, which is a core element of the Patient Protection and Affordable Health Care Act (PPACA). Two out of three judges found the mandate that forces individuals to purchase health insurance represents an unprecedented and unconstitutional expansion of the power of Congress to regulate interstate commerce.

Author: Michael Gomes

NAIC Produces Short Educational Video for Consumers Explaining PPACA

Last month, the NAIC published a brief video to help answer questions posed by consumers regarding the Patient Protection and Affordable Care Act (PPACA).[1] Brokers and agents may want to use this video as a reference tool for their clients.  Subjects covered by the video include:

  • Individual and employer mandates
  • Pre-existing conditions
  • Healthcare exchanges
  • Preventive care measures
  • Medicare. [2]

Click HERE to view the video.

Author: Michael Gomes

District Appellate Court Upholds Mandate to Purchase Health Insurance

On June 29, a three judge panel of the Sixth Circuit U.S. Court of Appeals located in Cincinnati, Ohio published an opinion on the case entitled, Thomas More Law Center et. al. vs. Barrack Hussein Obama et. al. [1]     

On a vote of 2 to 1, the Appeals Court upheld the constitutionality of the “individual mandate” embedded in the Patient Protection and Affordable Care Act (PPACA) that requires all individuals to purchase health insurance by the year 2014 or pay a penalty. In addition, the appellate decision sent minor shock waves through many conservative camps since this is the first time a republican appointed judge sided with the Obama administration. 

Author: Michael Gomes
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