HHS Issues New Rules on the Implementation of Health Insurance Reform

Earlier this month, the U.S. Department of Health and Human Services (HHS) released new proposed, final rules on a host of issues relating to the implementation of the Patient Protection and Affordable Care Act (PPACA). Many of these reforms will be implemented on January 1, 2014. The rule will be effective on April 30, 2013.

The rule, published on March 11, 2013, provides detail to a wide range of reforms under PPACA, covering additional explanations or updates to:

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.

Understanding the Impact of PPACA’s Health Insurance Premium Tax

Beginning in 2014, many Americans will start paying for a new tax on health insurance that will be assessed against health plans and insurers but will actually be paid through increased premium rates, according to several prominent insurance and financial experts. Buried within the Patient Protection and Affordable Care Act (PPACA), Section 9010 requires individuals, families, and others to help pay a total of $73 billion over five years.  Implementation of this provision is generating mixed reviews by various stakeholder groups.   

Federal Government Taps 32 Organizations to be Pioneer ACOs

On December 19, 2011, the U.S. Department of Health and Human Services (HHS) announced that the federal agency has approved 32 organizations to become Pioneer Accountable Care Organizations. 

Through the Patient Protection and Affordable Care Act (PPACA), the federal government has promised to deliver improved health care while attempting to better control future costs. Among other initiatives, the new health care reform law authorizes the creation of Accountable Care Organizations (ACOs). 

Pioneer ACO Initiative

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.

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.

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?

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).

Another Federal District Court Rules Against PPACA: Mandate to Purchase Health Insurance Deemed Unconstitutional

Recently, Judge Christopher Conner of the U.S. Court of the Middle District of Pennsylvania ruled in the case of Goudy-Bachman v. United States Department of Health and Human Services, No. 1:10-CV-763. Connor declared that the mandate in the Patient Protection and Affordable Care Act (PPACA) that requires individuals to purchase health insurance is unconstitutional. For a copy of the court ruling, click here.

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: