Matthew Bevin was elected governor of Kentucky in 2015 promising to end Kentucky's highly successful and widely praised state kynect marketplace. During the past year Kentucky has been working on transitioning from an integrated state-based marketplace to a state-based marketplace using the Healthcare.gov platform. On October 4, 2016, CMS Acting Administrator Andrew Slavitt wrote a letter to Governor Bevin stating that, based on Kentucky's successful completion of system readiness testing and of required milestones, "the Commonwealth has met the required transition milestones to date and demonstrated implementation of the system functionality necessary to operate kynect on the federal platform, and we are permitting the transition effective November 1, 2016."
The letter warned, however, that the transition "may disrupt the seamless system of coverage that kynect established" resulting in eligible people facing delays and lack of access to coverage in the Medicaid, CHIP, and marketplace programs. Whereas kynect offered consumers an integrated eligibility system, consumers may now have to start an application in one place and have their eligibility determined and enrollment completed in another with an intervening waiting period. CMS expressed concern that Kentucky implement a communications plan to clearly and effectively communicate to consumers the information they need to begin enrollment on November 1, 2016 and promised to review performance indicators as to timeliness of transaction processing and backlogs to monitor whether consumers receive coverage on a timely basis.
Insurer In Risk Corridor Case Requests Class Action
On October 5, 2016, the attorneys representing Health Republic in the United States Court of Claims suing the government for failing to make full payments under the ACA risk corridor program asked the court to certify a class of:
All persons or entities offering Qualified Health Plans under the Patient Protection and Affordable Care Act in 2014 and 2015, and whose allowable costs were more than 103 percent of their target amounts (as those terms are defined in the Patient Protection and Affordable Care Act).
This class would include all insurers eligible for risk corridor payments. The attorneys representing Health Republic also asked the court to appoint them as interim counsel to represent the class.
Health Republic argues that certification of a class action is appropriate under the federal rules because approximately 200 insurers have been injured by the government's failure to pay, they all present common issues of law and fact and have been treated similarly by the government, and these common issues predominate over individual issues particular insurers might present. Health Republic further argues that the issues it raises are typical for the class, that it can adequately represent the class, and that it faces no conflict of interest with respect to the class. Finally, it contends that a class action is superior to individual litigation for resolving the litigation.
There has been considerable speculation as to whether the administration in fact wishes to settle the risk corridor litigation. A decision to settle would be vigorously condemned by congressional Republicans, but might make sense if the administration believes that the cost of settlement would be less than the cost of litigating all the cases insurers could bring and satisfying judgments the Court of Claims might impose. If the administration is contemplating settlement, it would also make sense for it to agree to class certification and settle with the class of insurers as a whole. Any insurer that objected to the terms of the settlement would, of course, be able to opt out and litigate on its own, but a class settlement would most likely resolve the issue for most insurers.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2dyDDTi
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