A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Health Insurance

10.3 million adults estimated to have gained coverage under the ACA

Posted on July 24, 2014

A new study published in the New England Journal of Medicine found that an estimated 10.3 million adults gained insurance coverage under the Affordable Care Act (ACA).  The study, performed by Harvard researchers, reported a 5.2% decline in the uninsured rate during the first open enrollment period.  Data analyzed for this project included Gallup polls and ACA enrollment statistics from the US Department of Health and Human Services (HHS).

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Courts issue conflicting ACA decisions

Posted on July 22, 2014

Today, two federal appeals courts issued contradictory decisions regarding the availability of advanced premium tax credits, or subsidies, for federally-facilitated marketplaces (FFM).  In a 2-1 decision in Halbig v. Burwell, the US Court of Appeals for the DC Circuit ruled that the Internal Revenue Services (IRS) did not possess the authority to issue subsidies for qualifying individuals enrolling in FFM.  In a similar case entitled King v. Burwell, the Fourth Circuit Court of Appeals in Richmond unanimously upheld that subsidies may be offered by the IRS in both federally-facilitated and state-based Marketplaces.  Under the Affordable Care Act (ACA), individuals earning 400% or less of the federal poverty level may receive subsidies in order to offset some of the premium costs for obtaining health insurance through the ACA Marketplaces.  The differing opinions issued today indicate that this issue will likely be taken up by the Supreme Court.

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CMS releases proposed rule on annual eligibility determinations

Posted on June 26, 2014

A new proposed rule issued today by the Center for Consumer Information and Insurance Oversight (CCIIO) discussed annual eligibility redetermination under the Affordable Care Act (ACA) and several other enrollment standards for ACA Marketplace. CCIIO stated that nearly all of those currently enrolled in an ACA Marketplace plan will be re-enrolled unless they choose a new plan in the next open enrollment period or the plan in which they are currently enrolled is terminated. The rule proposes three methods for ACA Marketplaces to conduct annual redeterminations for enrollment. The rule also proposes standards to redetermine eligibility within a plan year and when an individual’s plan in the ACA Marketplace is not available for re-enrollment for the next plan year.

Additional guidance includes:

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Two new ACA studies released

Posted on June 26, 2014

A new study published in Health Affairs found that open enrollment for the Affordable Care Act (ACA) should coincide with the tax filing season. The researchers argued that consumers are more likely to make better decisions with their health coverage when taxes are on their minds, not the stresses associated with holiday spending. Currently, ACA open enrollment for 2015 is scheduled for November 15, 2014 to February 15, 2015.

Another study from the Urban Institute indicates that Medicaid expansion was associated with a reduction in the number of uninsured individuals as of March 2014. The study, which relied upon data from Urban’s Health Reform Monitoring Survey, found that states expanding Medicaid saw a drop in the uninsurance rate by 4%, whereas states that did not expand Medicaid saw a 1.4% reduction. Unlike the ACA open enrollment period, individuals eligible for Medicaid can enroll in the program at any point in a year.

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Rule finalizes 90-day waiting limit

Posted on June 20, 2014

Today, the US Department of Health and Human Services (HHS), the Internal Revenue Service (IRS) and the Employee Benefits Security Administration (EBSA) released a final rule concerning the 90-day waiting period limitation. The final rule states that group health insurance plans cannot apply a waiting period that exceeds 90 days after the employee has been approved for coverage. The rule further states that small group plan orientation periods, the time it takes from hire to when the plan deems the employee is eligible for coverage, cannot exceed one month.

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New brief discusses premium rate review

Posted on June 20, 2014

The Robert Wood Johnson Foundation and the Leonard Davis Institute of Health Economics at Penn released a brief on premium proposals and rate review under the Affordable Care Act (ACA). The brief, Deciphering the Data: Health Insurance Rates and Rate Review, discusses the economic, political, and regulatory factors that contribute to rate determinations. Additionaly, the brief discusses how states with prior approval for rate review authority increased their capacity and scope to coincide with requirements under the ACA.

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KFF survey discusses ACA “plan switchers”

Posted on June 19, 2014

A new survey conducted by the Kaiser Family Foundation (KFF) discusses the experience of individuals that were enrolled in the individual health insurance market prior to the Affordable Care Act (ACA), and then switched into the ACA health insurance Marketplace. The survey found that 46% of these individuals have lower premiums after switching to the ACA Marketplace, while 39% have higher premiums. Additionally, about 50% of these “plan switchers” received cancellation notices from their insurance issuers because their plans were deemed non-compliant with the ACA prior to the issuance of the transitional policy.

The survey also indicated that affordability is still an issue for individuals enrolled in ACA plans, as 6 in 10 of those surveyed fear their plans may become unaffordable in the future.

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ASPE report indicates premium variation among states

Posted on June 18, 2014

A new report by the US Department of Health and Human Services (HHS) describes how premiums vary among the 36 states operating federally-facilitated Marketplaces under the Affordable Care Act (ACA). The report, released by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within HHS, found the average premium payment by an individual receiving subsidies to be $82, with the subsidized average for the silver plan metal tier being $69. Average subsidized premiums ranged from $23/month in Mississippi to $148/month in New Jersey. The report does not capture the corresponding data for the state-based Marketplaces.

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CCIIO issues FAQ on ECPs

Posted on June 12, 2014

A new FAQ released by the Center for Consumer Information and Insurance Oversight (CCIIO) addresses questions insurance issuers may have concerning Essential Community Providers (ECPs). The Affordable Care Act (ACA) requires issuers to contract with a sufficient number of ECPs, or providers that generally treat low-income and medically underserved patients. The FAQ describes specifics of the ECP requirements, how issuers can access the non-exhaustive ECP list, and how ECPs can actively pursue inclusion in insurance planes. A similar FAQ addressing the same ECP issues was released in May of 2013.

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HHS releases final Marketplace rule

Posted on May 16, 2014

The US Department of Health and Human Services (HHS) issued a final rule entitled Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond. Some specific provisions in the rule include:

  • Raising the administrative costs and profits ceiling under the risk corridor formula by 2%.
  • Providing information on how to include ICD-10 costs under the medical loss ratio (MLR).
  • Requiring qualified health plans (QHP) on the ACA Marketplace to have a more efficient and effective method for enrollees to acquire medications not covered on the plan. This specifically applies to enrollees on a course of treatment in which absence of the medication would substantially impact the individual’s life and health.
  • Requiring insurers to annually report plan changes to beneficiaries.
  • Beginning in 2016, Marketplaces will have to display quality data on all plans for public viewing. The data will be based on a five-star system and enrollee satisfaction surveys.
  • Enumerating state requirements that may prohibit Navigators or other assistors from performing their roles. For example, Navigators may go door-to-door for enrollment assistance and outreach. They may not, however, provide gifts to entice enrollment.
  • Delaying the “employee choice” option in the small business health options program (SHOP) to 2016.

The final rule is largely unchanged from the proposed version. An FAQ addressing market reforms and Marketplace standards can also be accessed here.

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