insurance

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.

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

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.

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).

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: