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ACA health insurer fee: Estimated impact on the U.S. health insurance industry
15 Apr 2013
Mathieu Doucet | Julia Yahnke
One of the notable revenue provisions included in the Patient Protection and Affordable Care Act (ACA) is an excise tax on the health insurance industry that will be assessed annually starting in 2014.
This report provides an independent analysis of the impact of the ACA health insurer fee provision on the United States health insurance industry.
Considerations for Medicaid expansion through health insurance exchange coverage
11 Apr 2013
Robert Damler | Kaitlyn Shaw | Seema Verma
Arkansas has proposed using Medicaid expansion dollars to provide subsidies so that eligible individuals can purchase health insurance through the exchange. The U.S. Department of Health and Human Services has indicated that it will consider approving such proposals.
The Arkansas proposal has various financial implications, especially with regard to provider reimbursement levels and various aspects of the Patient Protection and Affordable Care Act, including the medical loss ratio requirement and the “Three Rs” (reinsurance, risk corridors, and risk adjustment). This healthcare reform briefing paper examines these key considerations for a state contemplating this approach.
Commercial risk adjustment and transfer payments: Are you ready?
07 Feb 2013
Corey N. Berger
With healthcare reform moving full speed ahead, the individual and small group markets will experience changes and challenges starting in 2014, including the introduction of risk adjustment and transfer payments for non-grandfathered plans.
Part of the healthcare reform legislation mandated that the U.S. Department of Health and Human Services (HHS) establish a transfer payment methodology between plans in these markets to help mitigate differences in the risk characteristics of members. The transfer payment methodology results in transfers between carriers on a zero-sum basis—if a plan is receiving a payment, that payment must come from another carrier. Carriers will have to submit accurate diagnosis codes to HHS to ensure their risk scores reflect the actual risk of their population.
This paper addresses both the operational challenges of submitting diagnoses and how the transfer payment will work, as well as key questions insurers need to be asking in order to be successful in the new environment.
The Affordable Care Act: Timeline of key deadlines between now and 2016
01 Feb 2013
As the Patient Protection and Affordable Care Act (ACA) moves forward, deadlines for implementation are fast approaching. This timeline contains the key deadlines for insurers through the end of 2016, including financial reporting dates and enrollment dates.
Healthcare CO-OPs: Opportunities and challenges
26 Dec 2012
Thomas D. Snook
The PPACA includes a provision authorizing the creation of what are called "Consumer Operated and Oriented Plans" (CO-OPs), which are meant to offer consumer-friendly, affordable health insurance options to individuals and small businesses. CO-OPs will be funded by federal loans in hopes that with more players in the healthcare marketplace, the additional competition will lead to a more efficient and less costly healthinsurance market. CO-OPs must make decisions now about building their organizations, designing their plans, enlisting providers, and how their marketing strategies. These financial and operational decisions must be made as soon as possible to ensure that CO-OPs file and receive state approval to be in place in January 2014. This article discusses the current operational challenges and opportunities for new CO-OPs.
Ten critical considerations for health insurance plans evaluating participation in public exchange markets
21 Dec 2012
Catherine Murphy-Barron | Craig Keizur | Jill Van Den Bos | Margaret Chance | Paul Houchens
The Patient Protection and Affordable Care Act (PPACA) will introduce new marketplaces for individual and small group health insurance, effective January 1, 2014, in the form of public exchanges. Health insurance plans need to fully prepare for and understand the impact that the public exchanges may have on their business. Whether or not a health plan participates, the logjam that blocked reform progress for several months appears to have been cleared; PPACA is now moving forward with weekly releases of regulations and rules (most are preliminary rules and open for comments). This momentum of rule writing brings new terminology and issues to light, which are critical to understand before making decisions on whether or not to participate in the public exchanges.
This paper provides 10 critical considerations based on the preliminary rule recommendations published in the last half of November. As these rules are finalized, the considerations and market dynamics may change.
A roundup of recent regulatory guidance on healthcare reform
20 Dec 2012
Federal agencies have issued several pieces of guidance for employee health benefit plan sponsors moving forward on implementing changes required under the health reform law (“PPACA”). The agencies also released guidance for other entities (insurance companies, primarily) that will be involved in health insurance offerings to individuals and small employers when the new exchanges become operational beginning in 2014.
This Client Action Bulletin discusses PCORI funding, a Medicare Part A payroll tax increase, guidance on transitional reinsurance fees and wellness programs, as well as other regulations related to healthcare reform. The bulletin also provides guidance on actions employers should undertake.
How can employers add incentive to a wellness programs?
Health reform may create an opportunity for employers contemplating new or expanded wellness programs. In the latest issue of Benefits Perspectives, Sharon Stocker examines keys to creating a valuable program, with an emphasis on effective communications to ensure employee engagement and participation.
Are more patients visiting doctors?
A recent American Medical News article suggests that a recovering economy and greater use of preventive care may be contributing to increases in spending on physicians.
Employers and the impact of healthcare reform: Plan design considerations
Healthcare reform is complex.
Health exchanges: Key issues for states
Consultants and clients, including the CFO of the Massachusetts Health Connector, discuss the dynamics of state exchanges.