HealthCheck, March 2017

Academy activities, legislative/regulatory updates, and more.

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March 8, 2017

Academy Activities

The Academy’s Individual and Small Group Markets Committee released three issue briefs on the possible implications and policy considerations regarding high-risk pools to cover high-risk enrollees, selling health insurance across state lines, and association health plans.

Members of the Academy’s Health Practice Council (HPC) met with federal lawmakers on Capitol Hill and with policymakers at several federal agencies on Feb. 16–17 to discuss issues related to the Affordable Care Act (ACA) and the reconciliation process to repeal and replace certain parts of the ACA.

The Individual and Small Group Markets Committee submitted a letter to the Centers for Medicare & Medicaid Services (CMS) on March 7 regarding the proposed rule on market stabilization. The committee also sent comments on March 8 to the U.S. House Committee on Education and the Workforce on H.R. 1101, the Small Business Health Fairness Act, related to association health plans.

Legislative/Regulatory Updates

House Republicans unveiled legislation on March 6 that would repeal and replace components of the ACA. The American Health Care Act would, among other things, eliminate the individual mandate, phase out the Medicaid expansion, repeal the cost-sharing subsidies, establish the patient and state stability fund to help with high-cost individuals, and eliminate many of the ACA’s taxes. House Republican leadership expects to mark up this legislation on March 8, with a potential floor vote the week of March 20.

CMS issued several key documents in the past month, including:


check markA proposed rule issued Feb. 15 that proposes changes to help stabilize the health insurance marketplaces, including increasing the de minimis variation (to -4/+2 percent) in the actuarial values used for determining metal levels of coverage for the 2018 plan year.

check markA draft bulletin released Feb. 17 for the proposed revised uniform timeline for submission of rate filings for 2017 single risk pool coverage. CMS also released an addendum to the final 2018 Letter to Issuers released on Dec. 16, 2016, to revise the application submission timeline for Plan Year 2018 Qualified Health Plan certification in the federally facilitated marketplaces.

check markA bulletin issued Feb. 23 announcing the extension of the transitional policy for non-grandfathered plans in the individual and small group health insurance markets through 2018. States can opt to allow issuers to renew transitional (grandmothered) coverage for a policy year starting on or before Oct. 1, 2018. These plans cannot extend past Dec. 31, 2018.

On Feb. 6, the IRS announced it will no longer require taxpayers to declare whether they have the essential minimum health insurance coverage required by the ACA when filing their tax return.

The U.S. Government Accountability Office released a biennial report Feb. 15 to congressional committees on “high-risk” federal programs, including Medicare, Medicaid, and Social Security Disability Insurance. The report identifies financially troubled programs that have unfunded liabilities or pose a hazard to the federal budget.

The U.S. House of Representatives and the Trump administration filed a joint motion in a federal appeals court on Feb. 21 to delay for three months any legal action regarding the appropriations of subsidy payments for health insurers. The HPC sent a letter to congressional leadership in December stating that eliminating the reimbursements to insurers for cost-sharing reduction subsidies could result in significant market disruption.

On Feb. 27, the IRS issued Notice 2017-20, which extends the period for an employer to give written notice to employees concerning a small employer health reimbursement arrangement. The U.S. Treasury Department and the IRS intend to issue more guidance to help employers comply with the written notice requirement.

Global Health Webinar to Examine
Long-Term Care Issues in U.S., Germany

The Academy and the International Actuarial Association Health Section (IAAHS) will host a webinar, “Global Perspectives on Long-Term Care: United States and Germany,” on Friday, March 24, from 10 to 11:30 a.m. EDT. Worldwide long-term care demand is expected to increase significantly in the coming decades because of longevity increases and advances in health technologies and treatment, and this webinar will highlight a new report issued by the IAA’s Population Issues Working Group while spotlighting the perspectives of the two countries. The webinar is free for Academy and IAAHS members. Register today.

In the News / Media Activities

Chris Hayes, host of the daily “All In With Chris Hayes” show aired nationwide on MSNBC, cited the Academy in a March 7 interview with House Energy and Commerce Committee member Buddy Carter (R-Ga.) regarding the aims of the recently introduced American Health Care Act (at the 1:45 mark).

An Associated Press story on selling health insurance across state lines quoted HPC member Barbara Klever on how premiums reflect the cost of care where an individual lives. More than 400 media outlets—including the Washington PostCNBCYahoo NewsBusiness InsiderBoston Globe, and U.S. News & World Report—published the story.

Senior Health Fellow Cori Uccello discussed the significance of the ACA’s cost-sharing reduction subsidies in an Axios story on top priorities for health insurers. An Advisory Board story on the health of the ACA exchanges quoted Uccello, who said that “what we know about enrollment at this time doesn’t signal the degree of shrinking enrollment expected in a premium spiral.”

In a Modern Healthcare story, Uccello discussed the impact of revised rate-filing deadlines for ACA marketplace single-risk pool health insurance for plan year 2018. Uccello’s comments were also cited in an Advisory Board daily briefing.

Fierce Healthcare mentioned Uccello’s comments from a recent Academy news release on the wide implications of details embedded in ACA reform approaches, and cited the Individual and Small Group Markets Committee’s three recent health care issue briefs. A Health Affairs Blog post cited the issue brief on association health plans.

A subscriber-only National Journal article on the future of the ACA cited HPC Vice President Shari Westerfield’s comment that rolling back some of the essential health benefits would lower premiums, but enrollees would get fewer benefits, too.

Health Affairs Blog post discussing the underlying forces that led to an average increase in premiums for marketplace plans cited the Academy’s issue brief on 2017 health premium drivers. A fact-checking article published by Politifact discussing the ACA’s premium changes also cited the issue brief., and Healthcare Intelligence Network cited the Individual and Small Group Markets Committee’s new health care issue briefs on association health plans, selling insurance across state lines, and high-risk pools.

A Bloomberg article discussing replacement options for the ACA cited the Academy’s issue brief on selling insurance across state lines. A column in the Brattleboro Reformer (Vt.) also cited the issue brief.

Business Examiner published a statement from Washington state Insurance Commissioner Mike Kreidler, who cited the key findings of the Academy’s recent analysis of the implications of allowing health insurance to be sold across state lines. The story was reprinted by The Lund Report.

Health Affairs Blog story addressing concerns about high-risk pools cited the Academy’s recent issue brief on alternative high-risk pool reimbursement programs.

The National Law Review published a story relaying the key findings of the Academy’s issue paper evaluating the health insurance individual market and reform options. The story was reprinted by JDSupra Business AdvisorLexology, and Mondaq.

The Georgetown University Health Policy Institute’s Center on Health Insurance Reforms published a blog post relaying the key findings of the Academy’s issue paper evaluating the health insurance individual market and reform options. The issue paper was also cited in a Healthcare Law Insights story about the potential impact of a “slow repeal” of the ACA.