HealthCheck, January 2018

Academy activities, legislative/regulatory updates, and more.

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January 10, 2018

Academy Activities

The Health Practice Council (HPC) submitted a letter to the U.S. House and Senate providing comments on the potential consequences of eliminating the Affordable Care Act’s (ACA) individual mandate. The mandate’s elimination, beginning Jan. 1, 2019, was included in the Tax Cuts and Jobs Act passed by Congress in late December and signed into law by President Trump on Dec. 22. The new law also includes a two-year expansion of the medical expense deduction. Read the Academy alert.

The HPC’s letter followed a similar one sent in November but noted that “strong alternative mechanisms to encourage enrollment and/or significant market stabilization provisions would be needed to counteract an elimination of the mandate. Without any offsetting actions, eliminating the individual mandate would result in lower enrollment, a deterioration of the risk pool, and higher premiums. Expanded availability of short-term duration policies and association health plans [AHPs] could exacerbate these results by reducing the barriers to non-compliant coverage.”

Legislative/Judicial/Regulatory Updates

check markThe U.S. Department of Labor (DOL) proposed a rule to expand AHPs on Jan. 4. Under the proposal, DOL would expand the criteria for determining which groups are eligible to purchase AHPs. Employers in the same geographical region or industry would be allowed to band together and form their own AHP, and sole proprietors and their family members would also be allowed to join. DOL is also seeking to “require and promote actuarial soundness, proper maintenance of reserves, adequate underwriting and other standards relating to AHP solvency.” Read the Academy alert.

check markThe Center for Consumer Information & Insurance Oversight (CCIIO), part of the Centers for Medicare & Medicaid Services (CMS), published the final 2019 Actuarial Value (AV) calculator and methodology on Dec. 28. CCIIO also published Medical Loss Ratio (MLR) data for the 2016 reporting year, including data from all insurers’ final MLR filings. In conjunction with the data, CMS has released a report summarizing MLR results for the 2016 reporting year. Read the Academy alert.

check markCMS approved a Section 1115 Medicaid waiver extension request by Mississippi on Dec. 28. The 10-year extension is the longest Medicaid waiver approved by CMS. The agency also approved a request from Texas to extend its Section 1115 Medicaid waiver.

check markA continuing resolution passed by Congress and signed into law by the president on Dec. 22 to fund the government through Jan. 19 included $2.8 billion in funding for the Children’s Health Insurance Program (CHIP). The legislation also included a waiver of the Statutory Pay-As-You-Go Act of 2010 (PAYGO), which prevents automatic spending cuts to certain programs, including $25.48 billion to Medicare, from taking place. Read the Academy alert.

check markCMS announced on Dec. 21 that 8.8 million Americans enrolled in health care coverage for 2018 through the federal health insurance exchange established by the ACA. This marks a small decline from the previous year, when 9.2 million Americans enrolled for health care coverage through the federal exchange. Read the Academy alert.

Life and Health Valuation Law Manual Available to Order

Be one of the first to have the 2018 Life and Health Valuation Law Manual. Available for delivery this month, the manual is designed to help appointed actuaries know the requirements of the NAIC model Standard Valuation Law and the Model Actuarial Opinion and Memorandum Regulation. The manual is available in online and CD-ROM versions, allowing you to order the format that best meets your needs. Order your copy today.

In the News

  • Senior Health Fellow Cori Uccello discussed short-term health policies in a CNN Money story examining how President Trump’s executive order on health care could affect health insurance options. The story was reprinted by more than 50 media outlets. Her comments on the potential consequences of eliminating the individual mandate were cited in a HealthDay story that was reprinted by more than 80 media outlets.

  • Healthcare Dive and Modern Healthcare cited the Individual and Small Group Markets Committee’s issue brief on AHPs. A Health Affairs Blog post on the Labor Department’s proposed AHP rule cited the Individual and Small Group Markets Committee’s letter to Congress last March on AHPs.

  • HealthPayer Intelligence and Becker’s Hospital Review both reported on the HPC‘s Dec. 12 letter to the U.S. House and Senate providing comments on the consequences of eliminating the ACA’s individual mandate under the Tax Cuts and Jobs ActFierce Healthcare cited the HPC’s Nov. 21 letter to the Senate providing similar comments.