Publication Announcement

This issue of HealthCheck is being published a week early to reach readers before the Thanksgiving holiday. The December issue is scheduled to be distributed on Friday, Dec. 23.

Academy Activities

The Academy’s Premium Review Work Group on Nov. 1 sent a letter [1] to the Massachusetts Senate regarding an amendment to the state budget bill that would require any disapproval of health insurance rates to be “supported by sound actuarial assumptions and methods.” The amendment was vetoed by Massachusetts Gov. Deval Patrick, but the veto was overridden in the Massachusetts House. The Senate’s attempt to override the veto on Nov. 16 failed.

Legislative and Regulatory Updates

The U.S. Supreme Court announced that it will hear a challenge to President Obama’s heath care reform law. The court said it will consider several arguments relating to the Affordable Care Act (ACA), including:

• whether the individual mandate is constitutional, and if not, whether that affects the feasibility of other provisions in the law;

• whether the challengers have standing to contest the law; and

• whether the expansion of the Medicaid program is constitutional.

The court is expected to hear arguments in March; a decision isn’t expected until June 2012.

The Senate passed HR 674 [2] on Nov. 10. The bill would amend the Internal Revenue Code by including Social Security benefits when determining eligibility for the new federal health insurance tax credit. The bill also would repeal the withholding requirement on some payments to government vendors.

The House Energy and Commerce Subcommittee on Nov. 15 passed HR 1173 [3], which would repeal the Community Living Assistance Services and Supports (CLASS) Act, a controversial long-term care program included in the ACA. The bill was introduced by Rep. Charles Boustany (R-La.) after the Department of Health and Human Services (HHS) announced its decision in October not to implement the CLASS Act. Sen. John Thune (R-S.D.) introduced a similar bill [4] in the Senate. Thune’s move was blocked by Sen. Jay Rockefeller (D-W.Va.), who suggested the program could be “amended through the legislative process to make it sustainable over the long term.”

In The News/Media Activities

HHS Secretary Kathleen Sebelius’ Oct. 14 announcement [5] that she could “not see a viable path forward” for implementing the CLASS Act inspired an Oct. 24 Society for Human Resource Management [6] (SHRM member login required) article on the future of long-term care. Steve Schoonveld, the co-chairperson of the Joint Academy and Society of Actuaries CLASS Act Task Force, was quoted in the article. Schoonveld said it could be beneficial for employers to enable employees to purchase long-term care coverage for their spouses or parents so that employees would not be forced to take time off to provide care.

   Secretary Sebelius’ announcement also prompted a joint hearing by two subcommittees of the U.S. House Energy and Commerce Committee. The Academy’s 2009 letter [7] to Congress that included an actuarial analysis of the CLASS Act by a joint Academy/Society of Actuaries work group was in the spotlight during the Oct. 26 hearing, which was broadcast by C-SPAN [8]. The Academy letter and study were cited and discussed by U.S. House Energy and Commerce Subcommittee on Health Chairman Joe Pitts (R-Pa.), and Reps. Charles Boustany (R-La.) and Phil Gingrey (R-Ga.).

Reps. Joe Courtney (D-Conn.) and Tom Cole (R-Okla.) co-authored an Oct. 31 op-ed published by Roll Call [9]. The op-ed, which focused on the tax treatment of health benefits under the ACA, cited a joint Academy and Society of Actuaries January 2010 technical report [10] regarding the excise tax contained in then-proposed health care reform legislation. The actuaries said the proposal, which would use premiums to measure the comprehensiveness of benefits, disproportionately could affect early retirees as well as small business and high-risk professionals—not because their plans are more generous, but because the cost of premiums for these groups tends to be high.

The Academy Risk Sharing Work Group’s Oct. 28 comment letter [11] to the Centers for Medicare & Medicaid Services (CMS) on the proposed rule for implementing risk-sharing mechanisms included in the ACA was cited in a Nov. 3 Bureau of National Affairs [12] article (subscription required). The work group wrote that despite the law’s guaranteed issue requirements, “risk selection still could occur if issuers are able to use non-health status information (such as consumer data) to estimate individual health spending and to target marketing materials to those with low expected health spending relative to others.” Consumer data from credit card transactions that indicate spending patterns and lifestyle choices increasingly are available to market researchers, the work group wrote. “Because risk adjustment will not be able to fully reflect the underlying risk of enrollees, CMS may wish to consider appropriate marketing restrictions or network adequacy requirements,” the actuaries wrote.

The Academy Medicare Steering Committee’s letter [13] to the Joint Select Committee on Deficit Reduction was cited and briefly discussed in a Kaiser Health News [14] feature. The letter, signed by steering committee Chairperson Edwin Hustead, urged the committee to address Medicare’s solvency and sustainability by developing proposals to slow health care spending growth.

News links are to external websites. The Academy is not responsible for the content of these websites.

Upcoming Health Care Reform Events

Health Plan Adoption of Online Tools to Satisfy Medical Loss Ratio Rebate Requirements and Prepare for Changes in Market Strategy [15]

Webinar: Nov. 29 (No fee charged)

Sponsor: America’s Health Insurance Plans (AHIP)

For a complete listing of upcoming and recent health care reform events click here [16].