Insuring Resources Commentary:
As I've mentioned I'm a member of the Wisconsin Insurance Commissioner's Health Insurance Advisory Council. Our next meeting is April 13 and I expect the issues detailed in the article below will consume the majority of our agenda and discussion.
As the article states implementation of health care reform is going to be job 1 for insurance commissioners over the next five to ten years.
I'm looking forward to aiding in the implementation.
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Health Care Implementation Details Discussed at the NAIC
By ALLISON BELL
National Underwriter
State regulators tried to get an idea of how big is big this past weekend as they talked about implementing the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.
President Obama created years–and possibly decades–of work for state insurance regulators, state health regulators, and the National Association of Insurance Commissioners, Kansas City, Mo., when he signed the bills creating PPACA and HCERA into law.
Policy experts are just starting to dig behind the act summaries and read the actual language in the new laws, but thoughts about just what state insurance regulators will have to do to put PPACA and HCERA into effect came up often at the NAIC’s spring meeting in Denver.
News surfaced that U.S. Health and Human Services Secretary Kathleen Sebelius, a former Kansas insurance commissioner and former NAIC president, already has hired Jay Angoff, a former Missouri insurance commissioner, to help her communicate with the NAIC and keep tabs on the private insurance market.
Kevin Lucia, a Georgetown University health policy researcher who receives NAIC funding to represent consumer interests in NAIC proceedings, tried to give members of the NAIC’s Consumer Liaison Committee an idea of the size of the task facing regulators by discussing PPACA provisions that refer directly to the NAIC.
The committee has posted Lucia’s list of those provisions on its Web site.
Some of the PPACA sections cited will do the following:
—Require the U.S. Department of Health and Human Services to consult with the NAIC to develop the summary of benefits and coverage disclosure documents required under the act.
—Create health plan external review procedures that must comply with the NAIC’s Uniform External Review Model Act.
—Require HHS officials to define permissible health insurance pricing age bands in consultation with the NAIC.
—Provide that the new health insurance exchanges must use a “uniform enrollment plan that takes into account criteria submitted by NAIC to HHS.”
—Require HHS to work with the NAIC to set the regulations needed to create the exchanges; establish qualified health plan requirements; and create risk-adjustment and reinsurance provisions and other terms of the insurance reform.
—Require NAIC to help figure out how commercial long term care insurance policies will or will not coordinate with the new CLASS Independence Benefit federal long term care benefits program.
Lucia suggests in a separate document that PPACA and HCERA indirectly will create a need for the NAIC to help with many other tasks.
“As states consider the list of legislative and regulatory tasks before them, many will seek other ‘best practice’ recommendations from NAIC, even if not required by the legislative language,” Lucia says in the document. “For example, new premium rate review standards, to be used by state and federal regulators in connection with the 2010 plan year, are an area in which the NAIC will likely need to play a larger role than the one envisioned in the federal legislation.”
NAIC will have just 6 to 9 months to give HHS officials recommendations about many PPACA and HCERA provisions, Lucia says in the document.
Also at the spring meeting, the NAIC took these actions:
—Adopted Actuarial Guideline 43-CARVM, which sets variable annuity reserving guidelines.
—Adopted a white paper on methods for helping troubled companies.
—Adopted a guideline on life and health guaranty fund disclosure notices.
In addition, the NAIC’s Internal Administration Subcommittee took these actions:
—Adopted a proposal to reinstitute salary increases for NAIC staffers effective July 1. Salaries were frozen July 1, 2009. The NAIC can increase salaries about 3.5% because its defined benefit pension plan has been doing better, officials say.
—Adopted a proposal to restructure the lines of credit that the NAIC provides for the Interstate Insurance Product Regulation Commission. The NAIC will defer principal and interest payments owed by the IIPRC until the IIPRC makes a profit of $250,000 or achieves an accumulated cash balance from operations of $500,000, officials say.
The NAIC’s Life Insurance and Annuities Committee took these actions:
—Released several valuation manual section drafts for public comment. They include sections on experience reporting requirements and reporting formats and a section on principles-based report requirements for business subject to a principle-based reserve valuation.
Also at the spring meeting, the Executive Committee of the NAIC announced it had established a Market Regulation Accreditation Task Force; a Multi-State Enforcement Task Force; and a Regulatory Modernization Task Force.
And in another development, the Accident and Health Working Group found that the 1985 NAIC cancer cost tables cannot be replaced because of a lack of data. The group is asking the American Academy of Actuaries, Washington, to help insurers and regulators cope with the deficiency by “giving “appropriate guidance on current application of the 1985 tables.”
Showing posts with label HIE. Show all posts
Showing posts with label HIE. Show all posts
Friday, April 2, 2010
Monday, March 22, 2010
More Details on Final Health Insurance Reform Bill
Insuring Resources Commentary:
I will now refrain from calling this a health care reform bill. This is health insurance reform and therefore is an ugly stepsister of true reform. This reform does not provide the incentives we need for quality and efficiency. Therefore, I do not believe it will rein in health care costs. Opportunity Lost.
The insurance reforms listed below are essential, there is no question about that. But the opportunity to make health care and health insurance affordable has been botched. The efficiency and quality incentives apply only to Medicare, which covers about 15% of Americans.
------------------
This list was posted by CBS News
Cost: $940 billion over ten years.
Deficit:
Would reduce the deficit by $143 billion over the first ten years. That is an updated CBO estimate. Their first preliminary estimate said it would reduce the deficit by $130 billion over ten years. Would reduce the deficit by $1.2 billion dollars in the second ten years.
Coverage:
Would expand coverage to 32 million Americans who are currently uninsured.
Health Insurance Exchanges:
The uninsured and self-employed would be able to purchase insurance through state-based exchanges with subsidies available to individuals and families with income between the 133 percent and 400 percent of poverty level.
Separate exchanges would be created for small businesses to purchase coverage -- effective 2014.
Funding available to states to establish exchanges within one year of enactment and until January 1, 2015.
Subsidies:
Individuals and families who make between 100 percent - 400 percent of the Federal Poverty Level (FPL) and want to purchase their own health insurance on an exchange are eligible for subsidies. They cannot be eligible for Medicare, Medicaid and cannot be covered by an employer. Eligible buyers receive premium credits and there is a cap for how much they have to contribute to their premiums on a sliding scale.
Federal Poverty Level for family of four is $22,050
Paying for the Plan:
Medicare Payroll tax on investment income -- Starting in 2012, the Medicare Payroll Tax will be expanded to include unearned income. That will be a 3.8 percent tax on investment income for families making more than $250,000 per year ($200,000 for individuals).
Excise Tax -- Beginning in 2018, insurance companies will pay a 40 percent excise tax on so-called "Cadillac" high-end insurance plans worth over $27,500 for families ($10,200 for individuals). Dental and vision plans are exempt and will not be counted in the total cost of a family's plan.
Tanning Tax -- 10 percent excise tax on indoor tanning services.
Medicare:
Closes the Medicare prescription drug "donut hole" by 2020. Seniors who hit the donut hole by 2010 will receive a $250 rebate.
Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs. The bill also includes $500 billion in Medicare cuts over the next decade.
Medicaid:
Expands Medicaid to include 133 percent of federal poverty level which is $29,327 for a family of four.
Requires states to expand Medicaid to include childless adults starting in 2014.
Federal Government pays 100 percent of costs for covering newly eligible individuals through 2016.
Illegal immigrants are not eligible for Medicaid.
Insurance Reforms:
Six months after enactment, insurance companies could no longer deny children coverage based on a preexisting condition.
Starting in 2014, insurance companies cannot deny coverage to anyone with preexisting conditions.
Insurance companies must allow children to stay on their parent's insurance plans through age 26.
Abortion:
The bill segregates private insurance premium funds from taxpayer funds. Individuals would have to pay for abortion coverage by making two separate payments, private funds would have to be kept in a separate account from federal and taxpayer funds.
No health care plan would be required to offer abortion coverage. States could pass legislation choosing to opt out of offering abortion coverage through the exchange.
**Separately, anti-abortion Democrats worked out language with the White House on an executive order that would state that no federal funds can be used to pay for abortions except in the case of rape, incest or health of the mother. (Read more here)
Individual Mandate:
In 2014, everyone must purchase health insurance or face a $695 annual fine. There are some exceptions for low-income people.
Employer Mandate:
Technically, there is no employer mandate. Employers with more than 50 employees must provide health insurance or pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance. Fines applied to entire number of employees minus some allowances.
Immigration:
Illegal immigrants will not be allowed to buy health insurance in the exchanges -- even if they pay completely with their own money.
I will now refrain from calling this a health care reform bill. This is health insurance reform and therefore is an ugly stepsister of true reform. This reform does not provide the incentives we need for quality and efficiency. Therefore, I do not believe it will rein in health care costs. Opportunity Lost.
The insurance reforms listed below are essential, there is no question about that. But the opportunity to make health care and health insurance affordable has been botched. The efficiency and quality incentives apply only to Medicare, which covers about 15% of Americans.
------------------
This list was posted by CBS News
Cost: $940 billion over ten years.
Deficit:
Would reduce the deficit by $143 billion over the first ten years. That is an updated CBO estimate. Their first preliminary estimate said it would reduce the deficit by $130 billion over ten years. Would reduce the deficit by $1.2 billion dollars in the second ten years.
Coverage:
Would expand coverage to 32 million Americans who are currently uninsured.
Health Insurance Exchanges:
The uninsured and self-employed would be able to purchase insurance through state-based exchanges with subsidies available to individuals and families with income between the 133 percent and 400 percent of poverty level.
Separate exchanges would be created for small businesses to purchase coverage -- effective 2014.
Funding available to states to establish exchanges within one year of enactment and until January 1, 2015.
Subsidies:
Individuals and families who make between 100 percent - 400 percent of the Federal Poverty Level (FPL) and want to purchase their own health insurance on an exchange are eligible for subsidies. They cannot be eligible for Medicare, Medicaid and cannot be covered by an employer. Eligible buyers receive premium credits and there is a cap for how much they have to contribute to their premiums on a sliding scale.
Federal Poverty Level for family of four is $22,050
Paying for the Plan:
Medicare Payroll tax on investment income -- Starting in 2012, the Medicare Payroll Tax will be expanded to include unearned income. That will be a 3.8 percent tax on investment income for families making more than $250,000 per year ($200,000 for individuals).
Excise Tax -- Beginning in 2018, insurance companies will pay a 40 percent excise tax on so-called "Cadillac" high-end insurance plans worth over $27,500 for families ($10,200 for individuals). Dental and vision plans are exempt and will not be counted in the total cost of a family's plan.
Tanning Tax -- 10 percent excise tax on indoor tanning services.
Medicare:
Closes the Medicare prescription drug "donut hole" by 2020. Seniors who hit the donut hole by 2010 will receive a $250 rebate.
Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs. The bill also includes $500 billion in Medicare cuts over the next decade.
Medicaid:
Expands Medicaid to include 133 percent of federal poverty level which is $29,327 for a family of four.
Requires states to expand Medicaid to include childless adults starting in 2014.
Federal Government pays 100 percent of costs for covering newly eligible individuals through 2016.
Illegal immigrants are not eligible for Medicaid.
Insurance Reforms:
Six months after enactment, insurance companies could no longer deny children coverage based on a preexisting condition.
Starting in 2014, insurance companies cannot deny coverage to anyone with preexisting conditions.
Insurance companies must allow children to stay on their parent's insurance plans through age 26.
Abortion:
The bill segregates private insurance premium funds from taxpayer funds. Individuals would have to pay for abortion coverage by making two separate payments, private funds would have to be kept in a separate account from federal and taxpayer funds.
No health care plan would be required to offer abortion coverage. States could pass legislation choosing to opt out of offering abortion coverage through the exchange.
**Separately, anti-abortion Democrats worked out language with the White House on an executive order that would state that no federal funds can be used to pay for abortions except in the case of rape, incest or health of the mother. (Read more here)
Individual Mandate:
In 2014, everyone must purchase health insurance or face a $695 annual fine. There are some exceptions for low-income people.
Employer Mandate:
Technically, there is no employer mandate. Employers with more than 50 employees must provide health insurance or pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance. Fines applied to entire number of employees minus some allowances.
Immigration:
Illegal immigrants will not be allowed to buy health insurance in the exchanges -- even if they pay completely with their own money.
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