Reform

2012 PPACA Implementation Highlights

The implementation train for the Patient Protection and Affordable Care Act (PPACA) continues to pick- up speed with a number of important implementation dates in 2012. 

Keeping up with the pace can be challenging. To assist, the U.S. Department of Health and Human Services (HHS) offers  a website that helps track the major reform efforts, titled “What’s Changing and When.” Also useful is an online article posted by the White House that gives a year-by-year overview of the PPACA timeline.    

Here’s a snapshot of some 2012 milestones:

Accountable Care Organizations

Author: Michael Gomes

Obama Administration Defends Affordable Care Act in Opening Brief Filed with U.S. Supreme Court

On January 6, 2012, the U.S. Department of Justice (DOJ) filed a brief with the U.S. Supreme Court in support of the Patient Protection and Affordable Care Act (PPACA), one of the most talked about pieces of legislation passed in recent memory. In addition, over a half dozen amicus curiae briefs have been filed since then by interested parties wanting to weigh in on the case.  Oral arguments on the merits of the new health care reform law are scheduled for late March. 

Author: Michael Gomes

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.

Author: Michael Gomes

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.

Author: Bernard DiFiore

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.  

Mercer Study

Author: Michael Gomes

NAIC Approves Resolution Calling for Changes to MLR

The National Association of Insurance Commissioners (NAIC) has passed a resolution (26-20-5) to change health care reform laws related to Medical Loss Ratio. They are recommending that the Department of Human Health and Services (HHS) and Congress work to ensure that the role of professional health insurance agents remains a strong part of the healthcare process. The NAIC resolution strongly supports the need of agents to serve as consumer advocates in the process of securing health care coverage.

This is a huge step in the right direction for the broker/agent community. After a 90-minute debate, this vote took agents one step closer to overcoming their many obstacles of health care reform. Together, we will now wait to see the response that HHS has to these recommendations. BenefitMall has and will continue play an active role in supporting brokers and their role by lobbying, testifying and calling on officials to educate them about the value broker advisors bring to the health care process.

Click here to view a NAHU press release that further explains NAIC's resolution.

Author: Michael Gomes

Another Federal Court Weighs In On Health Care Reform: D.C. Federal Circuit Court Finds PPACA Constitutional

In a split opinion, a three-judge panel of the D.C. Federal Circuit Court of Appeals has ruled the mandate to force individuals to purchase health insurance constitutional, rejecting the appeal in the case of Seven-Sky v. Holder. In a 2-to-1 decision, the judges held that Congress acted within its authority to regulate interstate commerce when it enacted the individual mandate. The dissenting judge argued that the challenge was premature.

The opinion surprised some observers since two of the three justices on the panel were appointed by two Republican Presidents. 

The swing decision was put into play by Senior Judge Laurence Silberman, who was appointed to the Circuit Court by President Ronald Regan and is regarded by many to be one of the intellectual leaders of the conservatives on the federal bench. His opinion in this case categorically rejected the points challenging the individual mandate. While admitting that the mandate is unprecedented, his majority opinion offers the following comments:  

  • “Broad regulation is an inherent feature of Congress’s constitutional authority in this area; to regulate complex, nationwide economic problems is to necessarily deal in generalities.”  
  • "The right to be free from federal regulation is not absolute and yields to the imperative that Congress be free to forge national solutions to national problems.”  
  • "The health-insurance market is rather a unique one, both because virtually everyone will enter or affect it, and because the uninsured inflict a disproportionate harm on the rest of the market as a result of their later consumption of health-care services.”

In a dissenting opinion, Judge Brett Kavanaugh, an appointee of Republican President George W. Bush, contended that the Anti-Injunction Act applied to the case. The federal Anti-Injunction Act provides that no legal action can be taken against a federal tax until the tax is levied, and the tax provisions of the individual mandate do not take effect until 2014. He held that the court can't review the health care mandate until it and the tax penalty written into the Internal Revenue Code takes effect in 2014.

While the D.C. Federal Circuit Court ruling is notable, it is more symbolic in light of the U.S. Supreme Court’s decision to hear these issues (click here to read more). However, the ruling does bear some significance for individual mandate proponents since this is the second federal court with a Republican-appointed judge to vote to uphold the mandate.  

The ruling also softened the impact of the election results in Ohio on November 9th, where the citizens voted nearly 2 to 1 to amend their state Constitution to prohibit enforcement of the individual mandate. That vote is also largely symbolic, but PPACA opponents are using the vote in Ohio -- a swing state in the upcoming presidential election – to reinforce their claim that the individual mandate remains highly unpopular with voters.

Ultimately, each of these legal questions will be addressed by the U.S. Supreme Court next spring. 

We will continue to endeavor to keep you up-to-date on these and other developments in our ever- evolving marketplace. Please visit www.HealthcareExchange.com for blog posts, polls, surveys and numerous resources, or you may visit www.benefitmall.com to view past Legislative Alerts.

Author: Michael Gomes

Obama Pulls PPACA's Long-Term Care Insurance Program

Last week, the U.S. Department of Health and Human Services (HHS) announced that the Obama Administration would not be implementing the long-term care insurance plan included in the Patient Protection and Affordable Care Act (PPACA).   

Author: Michael Gomes

Institute of Medicine Releases Report on Essential Health Benefits: Concerns Remain about Establishing Accurate Baseline Premium Assumptions

One of the hallmarks of federal health care reform efforts is to provide standardized insurance coverage to small employer groups and individuals through state-based exchanges when federal subsidizes are warranted. Yet, concerns have grown over the past year about the emerging price tag associated with some of the mandates issued pursuant to the Patient Protection and Affordable Care Act (PPACA). 

Author: Michael Gomes

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:

Author: Bernard DiFiore
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