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.
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.
New Research Indicates Most Employers Will Continue to Sponsor Health Benefits for Employees Despite PPACA Mandates
Four recent surveys confirm the notion that the majority of employers will continue to offer employer-sponsored health benefits in 2012 and beyond. The national surveys, conducted by Mercer, Towers Watson Health Care, GfK and Kaiser Family Foundation/Health Research & Educational Trust, yielded fairly consistent results that indicate employers overall continue to view their health benefits plans as a key component of the employee benefit offerings. The survey feedback also confirms that few employers plan to terminate their health benefit plans when state health insurance exchanges, mandated by the Patient Protection and Affordable Care Act (PPACA), become operational in the fall of 2013.
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.
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.
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. 
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.
Department of Labor Delivers Selected Medical Benefits Report: HHS to Define Standardized Benefit Offerings
One of the more influential mandates put into place by 2010’s Patient Protection and Affordable Care Act (PPACA) is the requirement that every state have a public health insurance exchange. The legislation gave states the option to either create their own insurance exchange (and receive various grants from the federal government) or to let the federal government create the exchange for them.
A major step involved in creating state-run health exchanges is making sure insurance plans offered by the state-run exchanges are on par with those offered by private providers. PPACA mandates that health plans offer an “essential health benefits package,” a minimum of benefits provided by every plan through the state exchanges. The essential health benefits package is, according to PPACA, to be defined by the Secretary of the Department of Health and Human Services (HHS). To help determine what the package should be, PPACA also directs the Department of Labor (DOL) to conduct a survey of employer-sponsored health plans in order to determine the types and numbers of benefits usually covered by employers, and to report the results of the survey to HHS.