109 Sable Trace Lane
Acworth Ga, 30102-7621


Phone/Fax: 678-574-8421

ACA update week of September 14, 2015

Week of September 14, 2015
A federal judge ruled last week that the House has the right to sue the Obama administration over billions of dollars in health care spending as part of the law's risk sharing programs. However, the judge dismissed a House claim that the Obama administration had improperly moved the deadlines for new employer requirements.


The House Subcommittee on Regulatory Reform, Commercial and Antitrust Law, held a hearing last week on the Affordable Care Act (ACA) and health care competition, during which the issue of health insurance consolidation was raised. Representatives of certain hospital and physician groups testified that currently proposed health insurance acquisitions, including that of Humana by Aetna, could reduce competition. However, Dan Durham, an Executive Vice President with America's Health Insurance Plans (AHIP), testified that, "It is important to recognize that this competition among health plans occurs at the local level in specific geographic areas, and that new coverage options – including those resulting from collaboration between plans and providers – are emerging and evolving on an ongoing basis. The diversity of AHIP's membership – which includes local, regional, and national insurers – reflects the many choices consumers have when shopping for health insurance coverage in their area."

The House Energy and Commerce Committee, Subcommittee on Health, held a hearing on the expansion of the small group market from 50 to 100 employees. The impact of the small group size change is scheduled to take effect in 2016. Legislation in the House of Representatives would amend the ACA to designate employers with 51 to 100 employees as large employers, effectively preventing the expansion.

On September 3, The Department of Health and Human Services (HHS) proposed Section 1557 Non-Discrimination rule under the ACA. The proposed rule extends all civil rights obligations to the health insurance exchanges and other HHS health programs and activities. In addition, the proposed rule establishes that the prohibition on sex discrimination includes discrimination based on gender identity.

The Centers for Medicare & Medicaid Services (CMS) has posted the 2017 proposed Essential Health Benefits (EHB) benchmark plans by state. The ACA requires non-grandfathered health plans in the individual and small group markets to cover EHB within 10 benefit categories.

CMS issued $67 million in ACA Navigator grants to 100 organizations in 34 states to help consumers sign up for health insurance coverage on the exchanges in 2016. Funded organizations can provide consumers with in-person help, answer questions about plan options and financial assistance, and assist consumers in completing applications.

The Center for Medicare and Medicaid Innovation (CMMI) announced a five-year, Value-Based Insurance Design (VBID) Demonstration to begin in 2017. It would test whether or not allowing Medicare Advantage (MA) plans in seven states to target benefits to specific populations will lead to lower costs and better outcomes.

From Aetna health reform weekly


ACA update week of September 21, 2015

Week of September 21, 2015
The U.S. Census Bureau's annual report on income, poverty and health insurance coverage in America shows, as expected, that the nation's uninsured rate dropped significantly from 2013 to 2014. The report found that the percentage of people without health insurance coverage dropped from 13.3 percent (41.8 million) for all of 2013 to 10.4 percent (33 million) for all of 2014.


A D.C. Circuit Court judge issued an order last week to prevent the Obama administration from enforcing a rule restricting the sale of fixed indemnity insurance plans to individuals if they do not meet the Affordable Care Act's (ACA) minimum essential health coverage requirements. In his opinion, Judge Royce Lambert found that the rule is not consistent with an existing statute that explicitly allows the sale of fixed indemnity plans.

HealthCare.gov CEO Kevin Counihan has announced that the Obama administration will proceed with its planned change to out-of-pocket cap calculations. Under the guidance, the out-of-pocket cost for individuals enrolled in family plans would be capped at the individual limit of $6,850 per year, instead of the family limit of $13,700. Certain industry groups and employers argue that this change would increase prices and add administrative complexity to plan administration.

The Congressional Budget Office (CBO) released a report indicating that a House bill giving states the ability to choose whether or not to expand their small group market size to 100 employees could raise $400 million in revenue over the next 10 years.

A bill that would remove the ACA's caps on health savings accounts and flexible spending accounts has passed by a voice vote out of the House Ways and Means Committee. Sponsored by Kansas Rep. Lynn Jenkins, the Restoring Access to Medication Act would also allow individuals to use funds from their accounts to pay for over-the-counter drugs in addition to prescription medication

From Aetna health reform weekly


ACA update August 31, 2015

Week of August 31, 2015
A new analysis from the Kaiser Family Foundation has found that 26 percent of employers offering health care benefits to employees today could be subject to the Affordable Care Act's (ACA) "Cadillac tax" in 2018. The analysis also estimates that the percentage could grow to 30 percent in 2023 and 42 percent in 2028 if there are no changes to the plans and if health care costs continue to rise at expected rates.


Congress is now recessed until early September.

From Aetna health reform weekly