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.

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.

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.

Andy Large

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.

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.

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.

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.