For the past nearly seven years, the HHS blog has regularly highlighted the achievements of the Affordable Care Act. With the change in administrations, the change in the HHS blog has been dramatic. On March 14, 2017 it carried a post praising the proposed Republican American Health Care Act (AHCA). On the same day it carried a statement from Secretary Price challenging the Congressional Budget Office (CBO) report questioning the effects of the AHCA.
On March 20, 2017, the about-face continued, with a post carrying an announcement of a new website highlighting HHS actions to roll back Affordable Care Act requirements.
Transitional Plans
The website, titled "Providing Relief Right Now for Patients," lists three current HHS initiatives. The first of these, "Helping Patients Keep Their Plan," highlights the administration's decision to extend access to transitional plans for another year. It asserts, "This decision will help ensure lower premiums and real choices for millions of Americans, especially entrepreneurs, early retirees, and employees of small businesses." Transitional coverage does potentially offer lower premiums to those who qualify for it. Not noted on the website, however, is that such coverage is only available to people who have had continuous coverage since 2013, can impose annual and lifetime limits and preexisting condition exclusions, and is not required to cover the ACA's essential health benefits or limit out-of-pocket expenditures.
More Time For Insurers
The second entry, titled, "More Calendar Flexibility = More Options for Patients," notes the decision of HHS to extend the time allowed to insurers to file qualified health plans and rates for 2018. Given all of the uncertainty surrounding health care reform at this moment, this extension of time is certainly necessary.
Market Stabilization
The third entry, "Stabilizing the Market for Patients," praises the administration's proposed changes to various ACA market rules. Given the fact that these are proposed rules, on which the administration is currently reviewing public comments, the forcefulness with which the administration endorses the proposals is somewhat surprising.
Under the heading "Plans that Fit Your Budget," HHS praises its proposal to allow plans with lower actuarial values by increasing allowed "de minimis" variation in actuarial value. The entry states that this change would permit plans with lower premium so that "more Americans would be able to find plans that work for their budget." These plans, however, would have higher cost sharing and would result in lower premium tax credits, increasing the cost for premium tax credit recipients.
Under the heading "Plans that Work for Patients," the entry notes that HHS has proposed "lifting and streamlining one-size-fits-all requirements about what kind of access insurers have to offer," lowering regulatory costs, and providing "broader options for Americans who want affordable insurance." The proposal would end federal oversight of network adequacy requirements and leave to the states or accreditation agencies the task of determining when provider networks are too skimpy to provide basic health coverage.
Finally, under the heading "No More Gaming the System," the website recognizes the need for sick people to have access to health insurance, but claims that under current rules people are buying coverage while sick but dropping coverage while healthy. It makes the (disputed) statement, "The gaming of the system is pretty common." It then describes several provisions of the proposed rule intended to discourage this "gaming."
The first of these is shortening the open enrollment period for 2018 to 45 days, which HHS states will discourage healthy people from putting off purchasing coverage to the last moment. The second is the requirement that individuals document the occurrence of life events justifying a special enrollment period, which the post characterizes as a "commonsense requirement that would help hold premiums down by keeping out fraud." The previous administration noted that imposing documentation requirements cut down on special enrollments but disproportionately discouraged enrollments by younger consumers, potentially increasing premiums. The Obama administration had proposed a pilot project to determine whether increased verification requirements in fact discouraged gaming or instead simply discouraged healthy people from enrolling by increasing paperwork. The current administration has proposed moving ahead without testing the gaming hypothesis.
Lastly, the website praises a proposed rule to allow insurers to refuse coverage to consumers who owe them premiums for the prior year; it notes that fixing the "loophole," that allows individuals who owe premiums for a prior year to reenroll without catching up will "help insurers offer the best deal possible for Americans who are playing by the rules." Although this would seem like a straightforward proposal, it is noteworthy that the National Association of Insurance Commissioners, which represents the regulators charged with enforcing the rules, and which generally supported the administration's proposals, expressed concern regarding this one.
There is some concern amongst state regulators about the impact of the proposal to allow carriers to collect outstanding debts before effectuating enrollment in the same or different plan for the new year. State regulators would like to see more clarity in the regulatory language regarding what is meant by "non-payment of premiums" and "outstanding debt." There is concern that a consumer may have not paid premiums for legitimate reasons (such as, Exchange errors that enrolled the consumer in multiple plans) and that consumers may be required to pay for months during which they had no coverage under the grace period.
Elections have consequences, and the consequences of the 2016 election for health reform were expected. The changes visible at the HHS website are certainly among them.
Judge Dismisses Claims Brought By Co-op Liquidator
On March 16, 2017, Judge Rebecca Ebinger of the United States District Court for the Southern District of Iowa dismissed the complaint of the CoOpportunity Health insurance cooperative liquidator in Gerhart v. HHS. The lawsuit was brought by then Iowa Insurance Commissioner Nick Gerhart in May of 2016 as the liquidator of the failed CO-OP.
The liquidator sought access to funds owed by the federal government to the CO-OP for reinsurance, risk adjustment, and risk corridor payments. The federal government had put an administrative hold on these funds because the CO-OP also owed the federal government money, in particular for repayment of its $15 million start-up loan. The liquidators asked the court to rule that Iowa law governed the claim, declare that the administrative hold was arbitrary and capricious and order the federal government to release it, and bar the federal government from collecting risk adjustment funds that HHS claimed CoOpportunity owed. Judge Ebinger denied a preliminary injunction in the case in August of last year.
Judge Ebinger held that the claims at issue in the case were in fact claims for money against the United States and thus belonged in the Court of Claims and not in the federal district court. She further held that, standing alone, the choice of law claim was a request for an advisory opinion, not subject to the jurisdiction of the court. She therefore dismissed the case.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2nnyOyq
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