Academy activities, legislative/regulatory updates, and more.

Health Check Logo
January 11, 2017

Academy Activities

Academy volunteers addressed insurance regulators on a wide variety of health issues at the NAIC Fall 2016 National Meeting:

  • Shari Westerfield, vice president of the Academy’s Health Practice Council (HPC), updated the NAIC’s Health Actuarial (B) Task Force on the Academy’s recent public policy work at the state, federal, and international levels, including the HPC’s December letters to the U.S. House and Senate on potential adverse consequences of repealing provisions of the Affordable Care Act (ACA) without a replacement.

  • David Olsho, chairperson of the Academy’s Stop Loss Factors Work Group, summarized a recent report for the NAIC’s Health Risk-Based Capital (E) Working Group, which is reviewing the risk-based capital formula currently used for medical excess of loss business.

The LTC Reform Subcommittee submitted a comment letter on Jan. 6 to the Maryland Insurance Administration on long-term care (LTC) insurance. The letter was sent in advance of a public hearing held Jan. 9 regarding specific rate increase requests being made by certain LTC insurance carriers operating in Maryland. The letter emphasizes the importance of actuarial input regarding the consideration, design, and evaluation of a potential LTC policy approach. It also cites the subcommittee’s June 2016 issue brief, Understanding Premium Rate Increases on Private Long-Term Care Insurance Policyholders, and the November 2016 issue brief, Essential Criteria for Long-Term Care Financing Reform Proposals.

Legislative/Regulatory Updates

check markThe U.S. Senate voted 51-48 on Jan. 4 to begin efforts to repeal provisions of the ACA via the budget reconciliation process. This would allow for ending only tax or spending provisions of the ACA; such measures can be passed by a simple majority without being subject to a filibuster, which would require 60 votes to defeat.

check markOn Dec. 20, the Department of Health and Human Services (HHS) finalized new Medicare alternative payment models for cardiac and orthopedic care. The new bundled payment models would go into effect in July in 98 metropolitan areas and provide Medicare bonuses to clinicians who coordinate care and rehabilitation for patients receiving treatment for hip surgery, heart attacks, coronary bypass surgery, and cardiac rehabilitation.

check markThe Centers for Medicare & Medicaid Services released the 2016 Benefit Year Risk Adjustment: HHS-Developed Risk Adjustment Model Algorithm “Do It Yourself (DIY)” Software on Dec. 19.

check markThe U.S. Treasury Department and IRS on Dec. 14 released final regulations (T.D. 9804) in the Federal Register regarding the health insurance premium tax credit. The final regulations affect individuals who enroll in qualified health plans through health insurance exchanges and claim the premium tax credit; and exchanges that make qualified health plans available to individuals and employers.

In the News / Media Activities

More than 600 media outlets—including CNBC, MSN, Reuters, Yahoo Finance, Huffington Post, and Business Insider—have covered the HPC’s December letters to the U.S. House and Senate on the potential adverse implications of ACA repeal without immediate replacement. National Public Radio cited the letters in a story that was reprinted by nearly 90 media outlets.

An Associated Press fact-checking story quoted Senior Health Fellow Cori Uccello’s explanation that 2017 premium increases in a number of states are not necessarily indicative of an ACA premium spiral. More than 100 media outlets published the story, including the New York Times, CBS News, and NBC News.

A subscriber-only Bloomberg BNA story discussing a pilot program for tighter eligibility verification during ACA special enrollment periods quoted Uccello on balancing the need for documentation with the need for an enrollment process that is not onerous. A separate Bloomberg BNA story on ACA repeal efforts and potential changes to Medicare and Medicaid programs quoted Uccello on the difficulties of implementing certain proposed provisions such as continuous coverage without a full ACA replacement.

Call for Volunteers—Academy Seeks Pooled Health Plan Data

Section 3.7.7(b) of the revised ASOP No. 6, Measuring Retiree Group Benefits Obligations and Determining Retiree Group Benefits Program Periodic Costs or Actuarially Determined Contributions, calls for consideration of age-specific costs within a pooled health plan. One large pooled health plan, CalPERS, has made its age-specific cost data publicly available—a link to this data can be found on the Academy website. The Academy is interested in working with other pooled fund administrators to make similar data publicly available to actuaries.

If you are a health actuary who has worked with and/or has contacts at large pooled health funds across the country, and can assist in the Academy’s goal to make contact with large pooled fund administrators, we want to hear from you. If you can help, have any questions about this call for volunteer assistance, or need additional information, please contact Heather Jerbi, assistant director of public policy, at

Now Accepting Preorders: Life & Health Valuation Law Manual

The 2017 Life & Health Valuation Law Manual—designed to help appointed life and health actuaries comply with the requirements of the NAIC model Standard Valuation Law and the Model Actuarial Opinion and Memorandum Regulation—is now available for preorder. The manual includes a current-topics section outlining key valuation developments and state guidance, NAIC model laws and regulations that have an effect on reserve calculations, a discussion of generally distributed interpretations, and copies of the current actuarial guidelines from the NAIC Examiners Handbook. Reserve your copy today.