Healthcare Exchange

IRS/Treasury Department Public Hearing Exposes Divide Over Employer Mandate

Michael Gomes — Thu, 23 May 2013 17:15:22 +0000

An April 23 joint Internal Revenue Service (IRS) and Treasury Department hearing exemplified the split between labor and industry over how strictly the Employer Mandate (sometimes called the Shared Responsibility for Employers) provision of the Patient Protection and Affordable Care Act (PPACA) should be applied. A wide variety of stakeholders from the insurance brokerage, organized labor, education, legal and private industry communities testified before officials from the IRS and the Department of the Treasury on the controversial issue.

Federal Government Details Role of Brokers in PPACA’s Marketplaces/Exchanges

Michael Gomes — Tue, 21 May 2013 14:52:18 +0000

On May 1, the Center for Consumer Information and Insurance Oversight (CCIIO) released new guidance on the role of “agents, brokers, and web-brokers” in Health Insurance Marketplaces/Exchanges. CCIIO describes how they foresee Brokers operating:

“Agents and brokers, including web-brokers, are among those who will play a role in educating consumers about Marketplaces and insurance affordability programs, and in helping consumers receive eligibility determinations, compare plans, and enroll in coverage. In particular, CMS anticipates that Brokers will play a critical role in helping qualified employers and employees enroll in coverage through the Small Business Health Options Programs (SHOPs)”

A Glitch in PPACA and an IRS Regulatory Fix

Michael Gomes — Wed, 15 May 2013 18:38:46 +0000

A year-old Internal Revenue Service (IRS) rule regarding premium tax credits under the Patient Protection and Affordable Care Act (PPACA) faces controversy as it expands premium tax credits to people in states with a Federal Exchange. The rule was issued to address a missing provision in PPACA that would leave individuals in states operating under a federally operated health care Exchange ineligible for premium tax credits and lead to a serious challenge to the Employer Mandate. Now, two courts are hearing challenges to the IRS rule.

To recap, PPACA provides premium tax credits to people and households whose incomes fall between 133% and 400% of the poverty line who decide to buy health insurance on a state health benefits Exchange.

Recent Congressional Action Evidences Intent to Amend Large Employer Definition and Hourly Requirements under PPACA

Michael Gomes — Thu, 09 May 2013 15:24:11 +0000

In recent weeks, Congress has demonstrated an intent to change certain definitions and thresholds under the Patient Protection and Affordable Care Act (PPACA). On March 22, 2013, Senator Susan Collins (R-ME) submitted Amendment 144, which would change the definition of a large employer and remove the 30 hour requirement to be considered a full-time employee under PPACA. The legislative amendment would apply to the Senate Fiscal Year 2014 Budget Resolution (S. CON. RES.

Wellness Programs in PPACA Spotlight

Michael Gomes — Tue, 30 Apr 2013 15:42:21 +0000

Under the Patient Protection and Affordable Care Act (PPACA), wellness is one element of health care reform that is taking center stage.

Generally, health plans may not discriminate based on a health factor against individual participants with regards to eligibility, benefits, or premiums (health factors include health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, and disability). However, an exception to this rule allows for premium discounts, rebates, or modifications to otherwise applicable cost sharing in return for adherence to certain programs of health promotion and disease prevention, otherwise known as wellness programs.

The Employer Mandate and Controlled Groups

Michael Gomes — Thu, 25 Apr 2013 20:31:12 +0000

The Patient Protection and Affordable Care Act (PPACA) requires large employers – those with 50 or more full-time employees and full-time equivalents – to offer their employees the opportunity to enroll in coverage that is both affordable and provides minimum value. While determining whether an employer is subject to this employer mandate is complicated in its own right, this determination can get even more complex when several employers are commonly owned.

Bundling Multiple Employers

PPACA’s Impact on Insurance Premiums: Actuarial Study Predicts 32% Increase in Costs Over Next Five Years

Michael Gomes — Fri, 19 Apr 2013 14:53:42 +0000

A new report by the Independent Society of Actuaries predicts that individual market health insurers could experience as much as a 32% increase on average in health care costs from 2014 through 2017 due to changes brought on by the Patient Protection and Affordable Care Act (PPACA). This would result in higher premiums as the increased costs are passed on to those who purchase health insurance in the individual markets.

The report refers to an “average” increase in costs, but the actual increase in “per member per month” (pmpm) claims expenses will vary from state to state.

Proposed Rule Updates Role of Navigators, Non-Navigators in Exchanges

Michael Gomes — Wed, 17 Apr 2013 16:49:52 +0000

The Department of Health and Human Services (HHS) has released an interim final rule that clarifies the role of Navigator and non-Navigator assistance personnel employed by both state and federal health insurance Exchanges as established by the Patient Protection and Affordable Care Act (PPACA). The proposed rule was published in the April 5 Federal Register.

Navigators are those deemed by PPACA to provide assistance to consumers interested in purchasing health insurance coverage through state-based Exchanges. The non-Navigator assistance personnel are designated to provide additional consumer assistance, education, and outreach functions beyond the role of the Navigators.

Portion of Small Business Health Options Program Delayed to 2015

Michael Gomes — Fri, 05 Apr 2013 16:11:14 +0000

The Obama administration has announced via new rules that they will delay a portion of the implementation of the Small Business Health Options Program (SHOP) to 2015.

Proposed Legislation to Streamline Insurance Agent Licensing while Preserving Key Areas of State Authority

Michael Gomes — Tue, 02 Apr 2013 21:32:59 +0000

Legislation has been re-introduced in both the U.S. Senate and House of Representatives to help streamline insurance agent licensing between states while preserving key areas of state authority. Called the National Association of Registered Agents and Brokers Reform Act of 2013 (NARAB II), the bill would create an independent nonprofit entity comprised of insurance market representatives, state insurance commissioners, and other key stakeholders to help facilitate the ability of Brokers to sell insurance coverage in multiple jurisdictions.