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 April 29, 2013

A new Milliman report helps explain how the Affordable Care Act (ACA) will impact individual health insurance premiums as of 2014, when some of the more impactful ACA provisions take effect. With a broad range of changes happening under the law, the report emphasizes that some provisions will increase premiums while others will make health care coverage more affordable for consumers. The report found that “young, healthy males could see substantial increases due to the combination of the overall rate change and the age/gender rating requirements” while “older, less healthy individuals could see rate reductions.” The impact on specific individuals will vary significantly depending on their age, gender, location, health status, income level, and what coverage they have today.

In related news, the Bipartisan Policy Center has released a report titled “A Bipartisan Rx for Patient-Centered Care and System-Wide Cost Containment.” Among the group’s recommendations are improve and enhance Medicare to incent quality and care coordination, and reform tax policy and clarify consolidation rules to encourage greater efficiency and competition.


Gary Cohen, director of the CMS Center for Consumer Information and Insurance Oversight (CCIIO), testified last week on ACA implementation issues at a hearing in the House Energy and Commerce Subcommittee on Oversight and Investigations.  Cohen told the subcommittee that he is “optimistic and confident” about ACA implementation, indicating that every state will have a fully functioning “marketplace” (i.e., exchange) on October 1, 2013.  Cohen predicted robust competition in the exchanges, having been encouraged by the number of insurers submitting applications to participate in federally facilitated exchanges. In response to committee questions, Cohen said that “we’ll have to wait and see” about the ACA’s impact on premiums in 2014.  Cohen noted that the primary factor in determining health insurance premiums is the cost of medical care, and he stressed the need to address these costs.


ARIZONA: With the debate between Governor Jan Brewer and legislative leadership on Medicaid expansion continuing, the current legislative session is being extended on a week-by-week basis. April 23 marked the 100th day of the 2013 legislative session. Pursuant to legislative rules, the body should have adjourned on April 27. In other news, Fred DuVal, a longtime Democratic operative in Arizona and nationally, became the first member of that party to announce his candidacy for the 2014 gubernatorial election. 

CONNECTICUT: Access Health CT released its Qualified Health Plan (QHP) application on April 23 for the individual and Small Business Health Options Program (SHOP) exchange. Interested issuers are required to submit their applications by May 15th.   Meanwhile, the Department of Insurance is requiring all product and rate filings for the exchange to be submitted by April 30th.  Finally, the General Assembly has six weeks left in its regular legislative session with a number of health care bills as well as health-care-related items in the proposed biennium budget still pending.

FLORIDA: The legislature has passed extensive legislation related to ACA requirements that is now on its way to the governor for his signature.  He is expected to sign. Among other things, the legislation would suspend rate review by the Office of Insurance Regulation for 2014 and 2015.  Informational filings will still be required and can be reviewed by the state insurance department. Form filings will be required as usual, allowing the separation of experience for grandfathered and non-grandfathered plans. The legislation also includes allowing health plans to cease issuing conversion policies if similar benefits are otherwise available.

IDAHO: The exchange board held its first meeting last week, at which time board members established six committees: IT, Finance, Operations, Governance, Marketing and SHOP. Amy Dowd, a consultant at Ernst and Young who worked on the Oregon exchange has been selected as the executive director.

LOUISIANA: The House Committee on Health and Welfare voted along party lines last week to reject a bill that would have set in motion an expansion of the state’s Medicaid program as incentivized under the ACA. Gov. Bobby Jindal has openly opposed the proposed expansion, calling Medicaid badly flawed and in need of reform. The vote came after five hours of testimony. By opening up access to coverage for those making up to 138 percent of the FPL, the expansion would have provided coverage to as many as 653,000 poor Louisianans, according to a Department of Health and Hospitals.

OHIO: The debate over how to provide insurance coverage to more low-income Ohio residents will continue, but no legislative resolution will be included in the Senate version of the biennial budget package.  Instead, a study committee will be formed to discuss systemic Medicaid reform and identify the kind of program flexibility legislators need to see from the federal government. Currently 275,000 individuals earning less than 138 percent of the federal poverty level are targeted for additional coverage.  Governor John Kasich had included expansion of the Medicaid program in the biennial budget, but it was rejected by the House.  The study committee is tasked with making recommendations on a program that not only expands coverage but also provides incentives for workforce development and ways to reduce costs.  The group’s report is due no later than October. 

The House voted 87-7 last week to concur with Senate changes to a bill that would give the Department of Insurance more authority to regulate the professionals who will help Ohioans "navigate" coverage options in the new health insurance exchanges created by the ACA. The new language would establish educational requirements, background checks and other qualifications to serve as “Navigators” in Ohio.  Also, Aetna supported language that was added to the bill to ensure that health insurers can sell bronze and catastrophic plans in Ohio.  The bill now goes to the Governor for his signature.


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