Academy Activities

Learn more [2] about the review and disclosure requirements of “unreasonable” rate increases under the Affordable Care Act (ACA) at the Heath Practice Council’s Oct. 12 webinar. Members of the Rate Review Practice Note Work Group will provide an overview and answer questions about the final practice note (which will be released in October), Actuarial Practices Relating to Preparing, Reviewing, and Commenting on Rate Filings Prepared in Accordance with the Affordable Care Act.

In response to the recent Supreme Court decision that gives states the option of whether to implement the Medicaid expansion provision in the ACA, the Academy’s Health Practice Council released a new decision brief [3] that highlights some of the issues that federal and state policymakers and regulators should consider as they make their Medicaid expansion decisions. For more, see In The News.

Legislative and Regulatory Updates

The number and percentage of uninsured in the United States declined last year, according to a Sept. 12 report from the Census Bureau. In 2011, 48.6 million Americans (15.7 percent) were uninsured. That’s down from the 50 million uninsured Americans (16.3 percent) reported in 2010. The report, Income, Poverty, and Health Insurance Coverage in the United States: 2011 [4], also presents other statistics related to health insurance coverage, income levels, and poverty rates. Log in [5] to read the Academy alert about the Census Bureau report.

The IRS issued two notices on Aug. 31 on the ACA provision regarding employer-shared responsibility. The first notice, Determining Full-Time Employees for Purposes of Shared Responsibility for Employers Regarding Health Coverage [6], describes safe harbor methods for determining which employees are treated as full-time employees. The notice also states that—through at least 2014—employers can base affordability determinations on employees’ Form W-2 wages. The second notice, Guidance on 90-Day Waiting Period Limitation under Public Health Service Act § 2708 [7], defines “waiting period” and describes its application to variable-hour employees. The guidance will remain in effect through the end of 2014. The IRS is accepting comments on the two notices through Sept. 30.

The U.S. House Energy and Commerce Committee passed legislation on Sept. 20 that addresses the medical loss ratio (MLR). HR 1206, the Access to Professional Health Insurance Advisors Act of 2011 [8], exempts agent commissions from the MLR calculation stipulated under the ACA. The bill also requires the Department of Health and Human Services (HHS) to defer to a state’s decision on MLR waivers. With both the House and the Senate now in recess, any activity on the bill would not occur until later this fall.

The Rate Review Program has helped slow premium growth and has saved the American public $1 billion, according to the 2012 Rate Review Report [9] released by HHS on Sept. 11. The report focuses on three areas:

• Lowering rate increases and saving consumers money;
• Increasing transparency in the insurance market;
• Enhancing state rate review programs.

Health care will be one of the four domestic policy issues covered during the first presidential debate on Oct. 3, the Commission on Presidential Debates has announced. Jim Lehrer will moderate the 90-minute debate, which begins at 9:00 p.m. EDT. Presidential debates also are scheduled for Oct. 16 and Oct. 22.

In The News/Media Activities

The Academy’s 2010 MLR critical issues paper [10] was referenced in a Smart Business Aug. 29 online article, “How Health Insurance Companies and Employers are Dealing with the New Medical Loss Ratio Mandate [11].”

Implications of Medicaid Expansion Decisions on Private Coverage [3], the Academy’s recently released decision brief, earned significant coverage in the trade media and public policy blogs. Highlights include:

• Washington Post WonkBlog: “Medicaid opt-out states could increase your premiums—even if you have private insurance [12]”
• George Washington University Health Reform GPS: “Actuaries brief explores relationship between Medicaid expansion and premiums [13]”
• Law 360: “Medicaid Expansion will Keep Premiums Lower, Report Says [14]”
• LifeHealthPro: “What Private Medicaid expansion means for private plans [15]”
• CCH Health Reform Talk: “Employers at higher risk of ACA penalties depending on location [16]”

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

Upcoming Health Care Reform Events

State Issues Conference [17]

Conference: Oct. 3–5, Washington (fee charged)
Sponsor: America’s Health Insurance Plans

For a complete listing of upcoming and recent health care reform events click here [18].