BenefitMall Meets with Policymakers at the Capitol

Last week, BenefitMall representatives met with regulators and policymakers from several key agencies and associations. The goal of the meetings was to promote a substantive exchange of information leveraging BenefitMall’s experience and knowledge regarding the insurance marketplace and how to address several key challenges associated with the implementation of the Patient Protection and Affordable Care Act (PPACA).

In separate meetings over a three-day period, BenefitMall met with health policy staff who work with the U.S. Department of Health and Human Services (HHS), the National Association of Insurance Commissioners (NAIC), the National Conference of State Legislators (NCSL), American Health Insurance Plans, Blue Cross Blue Shield Association and the National Association of Health Underwriters.

Several common themes emerged during the meetings:

• Timelines
  • Both the public and private sector policy experts appear to be genuinely concerned about addressing PPACA’s quick timelines for implementation. Beyond the politics, there appears to be an apolitical sentiment that we need to move more slowly. However, the regulators would need additional legislative or regulatory guidance to change the major timelines that were established through PPACA statutory requirements.
• Exchanges¹
  • Most states are busy sorting out the governance structure of the public exchanges and beginning to identify some of the key exchange operational elements in 2011.
  • PPACA authorizes a variety of options related to how the exchange models can be configured ranging from the Massachusetts’ “active purchaser” model to Utah’s “all comers” approach.
  • The Small Business Health Options Program (SHOP) exchange concept appears to be a legislative after-thought and more details need to be sorted out.
  • The same rating rules should be implemented both inside and outside each public exchange to help avoid adverse selection.
  • Tracking eligibility for individuals and families overtime is going to be a challenge and might generate privacy concerns.
  • Policymakers were very interested in learning more about how private exchanges, such as BenefitMall, have been successful.
• Benefits
  • The definition of the essential benefit package(s) offered through the exchanges will have a profound impact on PPACA’s ultimate success.
  • Existing and future federal/state mandated benefits will likely be unaffordable.
  • After the BenefitMall meetings, regulators appear to have a greater understanding of the wide range of current benefit offerings (which supports the premise that one size does not fit all.)
• Funding
  • Many of PPACA’s original cost estimates were not accurate.
  • Significant cost and implementation challenges lie ahead – both at the state and federal levels.
  • The threat of de-funding PPACA and the ongoing budget battles are having a chilling effect on some regulatory activities.
• Understanding the Market
  • There appears to be a greater appreciation of how PPACA could help and hurt the private sector.
  • More attention needs to be devoted to the impact of PPACA’s insurance market reforms.
  • Regulators are interested in learning more about local market purchasing trends from experts like BenefitMall.
• Supporting the Consumer²
  • Meeting participants appear to recognize that inexperienced Navigators (a concept embedded in PPACA) should not replace the role of a licensed broker.
  • A greater awareness of the backend support services is more apparent, including the need for a broker’s services to help consumers answer health questions.

Current PPACA activities in the pipeline include:

• On Thursday, Representatives Mike Rogers and John Barrow introduced legislation to exempt broker compensation from the medical loss ratio calculations. (BenefitMall will provide more details on this proposed bill in our next Blog).
• A myriad of funding and defunding measures continue to wind their way through the halls of Congress.
• Health care providers continue to wait for the Centers for Medicare and Medicaid Services (CMS) to publish regulations governing accountable care organizations (ACOs).
• The Institute of Medicine is currently studying how PPACA’s Essential Benefit packages should be designed.³
• State activity continues to heat up with almost 500 bills recently introduced in the majority states which reference PPACA’s state-based exchanges.⁴
• The five court cases challenging PPACA’s individual mandate will likely be appealed to the U.S. Supreme Court.⁵
• With Republicans beginning to announce their intention to run for President, the 2012 campaign season will begin shortly – which will provide an opportunity to re-evaluate PPACA’s insurance market pre-suppositions and legislative policy goals.
• Congress is still addressing the repeal of the 1099 reporting requirements.⁶
• With 42 out of 100 Senators firmly opposed to the nomination of Don Berwick as CMS Administrator, President Obama will likely need to consider new candidates since 60 senators must vote for the nomination.

Interestingly, this week HHS Chief Sibelius again signaled more flexibility in how the states can implement PPACA. However, Republicans continue to complain that they are not seeing enough follow-up to these promises.⁷

BenefitMall will continue to offer its insights and insurance expertise to all public policymakers, who might have a legitimate question or otherwise need information. Although the implementation of PPACA continues to have a lot of moving parts, it is important that all of us encourage informed public policy decisions throughout the process. As BenefitMall meets with policyholders, we will continue to have the opportunity to present our Brief on Exchanges.

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As more information becomes available, BenefitMall is committed to keeping you up-todate in a timely manner. Visit www.BenefitMall.com to view past Legislative Alerts in the “Newsroom” section. Or, you may visit www.HealthcareExchange.com for blog posts, polls, surveys and numerous resources. If you have any questions, please contact your local BenefitMall Sales Team and they will be happy to assist you. Thank you for taking the time to read through this important notification.

The views expressed in this legislative alert do not necessarily reflect the official policy, position, or opinions of BenefitMall. This update is provided for informational purposes. Please consult with a licensed accountant or attorney regarding any legal and tax matters discussed herein.

1. BenefitMall’s Issue Brief on Exchanges at https://www.benefitmall.com/PORTAL/Portals/0/BenefitMall Brief.pdf

2. Unfortunately, many policy experts still believe that offering an online web portal will be enough to empower employers and individuals to make a health insurance purchasing decision. This is just not the case.

3. http://www.iom.edu/Activities/HealthServices/EssentialHealthBenefits.aspx 

4. Based upon Westlaw search run on March 17, 2011 (Search Terms “Patient Protection and Affordable Care Act” and “Exchanges” used in the same bill).

5. http://www.healthcareexchange.com/blog/michael-gomes/eleventh-circuit-court-appeals-hear-vinson-case-declared-ppaca-unconstitutional

6. https://www.benefitmall.com/PORTAL/Portals/0/Legislative Alert/20101029LegislativeAlert.pdf

7. http://www.politico.com/news/stories/0311/51269.html