Health Reform Weekly

A weekly compilation from Aetna of health care-related developments in Washington, D.C. and state legislatures across the country.


Week of August 25, 2014

Two new surveys appear to show that an increasing number of employers expect the Affordable Care Act (ACA) to begin having a more pronounced impact on costs in 2015 for employers and employees alike. The Empire State Manufacturing Survey and the Business Leaders Survey found that employers generally expect health coverage costs to increase by 10 percent in 2015. Half of manufacturers and one-third of service employers expect the ACA will be a significant factor. When asked if they were changing their plans in response to the ACA, 36 percent of manufacturers and 41 percent of service employers said they were not. Others reported they are planning to make changes ranging from higher deductibles to increased copays and employee premium costs.

Respondents to the surveys, however, reported that a somewhat larger proportion of employees would be covered than in the past. A story in the New York Times last week confirms that more people now seem to be getting health coverage through their workplace than in the past.


A recent report by the Treasury Department’s Inspector General for Tax Administration
reveals that the IRS does not know how many companies are subject to the 2.3 percent medical device tax imposed under the ACA. The report also notes that the IRS wrongly issued hundreds of penalties for failure to pay, and that many other companies paid too much or too little.

CMS has released its 2015 Certification Requirements for federally facilitated marketplace “navigators”.
The guidance notes that training will be available in early September 2014 through the Medicare Learning Network (MLN). The Center for Consumer Information and Insurance Oversight (CCIIO) will provide future updates on the exact date when the 2015 training will be available.


CALIFORNIA: A new field poll reportedly suggests that California voters are strongly supportive of Proposition 45, a ballot measure that would give California Department of Insurance and Commissioner Dave Jones rate review oversight authority in the individual and small group market.
 Polling indicates that about 70 percent of registered voters support the measure, 16 percent oppose it and 15 percent are undecided.  Proposition 45 is expected to be one of the most expensive battles on the November ballot.

KANSAS: A recent report from the Gallup-Healthways Well-Being Index survey shows that the adult uninsured rate in the state has increased by 5.1 percentage points, jumping from 12.5 percent in 2013 to 17.6 percent by mid-year 2014.
  Kansas Insurance Commissioner Sandy Praeger was among the doubters, saying the number appeared to be “an anomaly” because a spike of that magnitude in one year “would be unprecedented.”  But others seized on the numbers to score political points. Some said the state’s decision to join 23 other states in not expanding Medicaid contributed to the increase, although about 27,000 more Kansans are covered under the KanCare program today than a year ago. Others said the number was evidence that the Affordable Care Act was failing to achieve its primary goal of reducing the number of uninsured, despite commercial carriers reporting higher membership in their group and individual products compared to last year.

The Board of Licensure in Medicine has adopted a new board policy regarding telemedicine that makes clear a Maine medical license is required for the practice of telemedicine. Telemedicine/distance medicine is defined as the practice of medicine at a distance through the use of any electronic means. Under the policy, medical records must be accessible to local health care providers and local health care facilities upon request.  The telemedicine interaction must include all the recognized components of a patient-physician visit necessary to establish a diagnosis and provide treatment.  The interaction, treatment recommendations, and the issuance of prescriptions will be held to the same standards of appropriate practice as those in traditional face-to-face settings. Telemedicine physicians providing primary care, other than acute episodic care, must have a face-to-face visit with their patients at least once a year. The prescribing of all controlled medications via telemedicine is prohibited.

NORTH CAROLINA: The North Carolina General Assembly officially adjourned the 2014 “short” session last week without agreement on a Medicaid reform plan.
  Lasting much longer than most expected, the 2013-2014 biennium session was officially ended, as was any legislation still pending.  The General Assembly is currently scheduled to reconvene on January 14, 2015 for the long session. However, the legislature could reconvene sooner if called back by Governor Pat McCrory for a special session.  Over the course of the 2014 session, many of legislative leadership's priority items were approved, including teacher pay increases and adjustments to the second year of the biennial budget. Originally, members planned to come back in November for a special session to address Medicaid reform but that issue likely will wait until 2015.

The state’s insurance exchange, NY State of Health, has advised all participating plans of critical dates leading up to the next open enrollment session. NYSOH will be sending administrative renewal notices to enrollees in early October on a template developed by the state. This notice will satisfy the plan’s obligation under the state prior approval law.  The state Department of Financial Services anticipates finalizing, approving and posting premium rates in the individual and small group market by August 31.  The NYSOH also has revised guidance on how to handle enrollments for 2015 as well as terminations during the grace periods toward the end of 2014. The guidance reflects revised CMS guidance, which states an “applicant’s failure to pay premiums during previous enrollments is not an exception to this guaranteed availability requirement.”


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