Category: Uncategorized

To paraphrase Mark Twain, reports of ACA’s (Obamacare) death are greatly exaggerated. Today, 216 members have voted on the newly amended House bill (AHCA). Senate Republicans have already expressed concern with the bill (primarily the end of Medicaid expansion by 2020, the implementation of high risk pools and issues with the modification of the pre-existing condition provisions). It is pretty logical to assume that the Senate will alter the House bill as the Senate has traditionally been a more moderate voice. If the bill is moved to the center by Senate Republicans, is there any certainty that the conservative Freedom Caucus will go along with it, it’s something to ponder. In reality, there will be a significant period of time that there will not be clarity on Health Care.  For a very nice summary of how the AHCA may be modified, have a look at a nice summary from CNN.

http://www.cnn.com/2017/05/04/politics/republicans-health-care-donald-trump/index.html

What does that lack of clarity mean to Employers, Individuals and Insurance Carriers?  For Insurance Carriers, the term “Growing uncertainty” keeps coming up as justification by Insurance Carriers for leaving or consider leaving State Based Exchanges. Everyone seems to be concerned about this issue, and logically, uncertainty is the worst thing that an Insurance Carrier can have when trying to provide insurance. If there is uncertainty, it is entirely logical to have them consider leaving State Based Exchanges until there is clarity so that they can understand the actuarial risk involved in providing an insurance product. Think about it, for any business if you are tasked with providing a service and you do not know the “rules of engagement”, what would you do?

The following are excellent articles on Insurance Carriers potentially leaving State Based Exchanges in 2018.

http://uk.reuters.com/article/us-aetna-virginia-idUKKBN17Z2CS

 

http://www.zerohedge.com/news/2017-05-03/obamacare-implosion-iowa-wont-have-healthcare-access-2018-last-major-provider-pulls-

 

From an Insurance Carriers perspective on uncertainty, the following is an excellent article on Insurance Carriers push for clarity in their meetings with CMS on CSR payments in the future.

 

https://morningconsult.com/2017/04/18/insurers-push-aca-subsidy-payments-meeting-top-health-official/

No matter what benefits are provided, using what marketing approaches, the need to communicate those enrollments quickly and efficiently to insurance companies will be an ongoing need. SoftCare’s EnrollmentPlus was designed by an Advisory Council of industry enrollment experts to facilitate the easy implementation of electronic enrollments from Employer Groups through Enrollment Vendors to Insurance Carriers. Call us for more details on click on https://softcare.cominsurance-plans/ on how EnrollmentPlus can fit into your electronic enrollment architecture

Mike Cobban

Mike.cobban@softcare.com

Director of Operations and Support

SoftCare Solutions | A Division of MTBC

Since the demise of the AHCA there have been countless articles on what is next in the US Health Care marketplace. To paraphrase Dick Motta, “it isn’t clear until the fat lady sings”. We can take educated guesses but I defy anyone in early 2009 when the ACA was first enacted to have predicted what would be the landscape in April of 2017. From my perspective, the best guesses are doomed to be wrong but if you have some time, you should glance through a few interesting articles that give you clues to what may happen next.

The first is from the Hill and it details and innovative approach proposed by Republican Senators Lamar Alexander and Bob Corker to allow people to use their ObamaCare subsidies to purchase any state-approved plan on the private market if there are no insurers selling policies on the federal exchange in their county.

http://thehill.com/policy/healthcare/326506-gop-sens-propose-temporary-obamacare-fix

If you are interested in the future of health care for employers, Mintz Levin has an interesting take on what the impact of AHCA and its defeat will have on employers. Some are obvious. Fewer Medicaid-eligible individuals would mean more uncompensated care – a significant portion of the costs of which would likely be passed on to employers in the form of higher premiums. Some are not so obvious. States may create their own “play or pay” regulations (remember, the ACA was modelled in part after the Massachusetts 2006 Act Providing Access to Affordable, Quality, Accountable Health Care program colloquially referred to as Romneycare).  I would strongly recommend that you read the article at:

https://www.employmentmattersblog.com/2017/03/the-future-of-the-affordable-care-act-week-8-an-employers-guide-to-the-collapse-of-the-american-health-care-act-spoiler-alert-the-news-is-not-all-bad/

The most interesting thing is that the defeat of AHCA has derailed state plans for their own “play or pay” laws. Some “Progressive” states such as California, Illinois, Pennsylvania, and Wisconsin have considered single-payer proposals that could have been funded in part by AHCA’s provision to allow states easier approval processes for Medicaid Waiver’s to choose how their Medicaid monies should be used in their own states.

No matter what the changes to ACA and the insurance marketplace, SoftCare’s EnrollmentPlus was designed by an Advisory Council of industry enrollment experts to facilitate the easy implementation of electronic enrollments from Employer Groups through Enrollment Vendors to Insurance Carriers. Call us for more details on click on https://softcare.cominsurance-plans/ on how EnrollmentPlus can fit into your electronic enrollment architecture

Mike Cobban

Mike.cobban@softcare.com

Director of Operations and Support

SoftCare Solutions | A Division of MTBC

There have been ongoing discussions on the value of the ACA and the proposed AHCA and the strengths and benefits of both approaches.  The most important point that must be driven home is that to have an effective and viable healthcare system using the private model, you must have a way to control cost and risks for everyone involved as there must be an incentive for everyone to create a viable health care system.

David Blumenthal and Sara Collins wrote an excellent article on where the ACA and AHCA Fall short and what the Health Insurance Market really needs. The link to the Harvard Business Review article is below.

The key recommendations can be summarized:

• Creation of balanced risk pools that include both healthy and less healthy persons in individual insurance markets. The pools must include incentives to allow healthy young people to join the risk pool. Their approach is to make the penalty for not signing up the same as having insurance. Controversial, perhaps but logical as the pool of enrollees must be balanced or insurance carriers will opt out (see https://www.nytimes.com/2017/04/03/health/iowa-healthcare-wellmark-blue-cross-blue-shield-obamacare.html?_r=1). 
• Another concept is toextend subsides higher up the income scale to purchase insurance. It’s a sad fact that health insurance has become so expensive that without assistance from employers or through subsides; middle class homes can’t afford insurance. This is a massive issue as these middle class families represent precisely the right persons to add to the risk pool as they tend to be lower cost and risk individuals.
• To ensure private insurers will participate, the business of selling this type of product must be viable. This means managing the inherent uncertainties associated with selling insurance in comparatively unpredictable individual markets through the use of reinsurance and risk corridors. Risk corridors protect plans that accumulate unexpectedly high risks by giving them access to funds collected from insurers that experience unexpectedly low risks.
• Public and private stakeholders must accelerate efforts to control the costs of health care services. If every other industrialized nation finds it easier to insure their entire populations at half the cost, there are lessons to be learned (an excellent article on this was published by the Commonwealth Fund in October 2015 – http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective).

If you are interested in the future of health care, I would strongly recommend that you read the article at:

https://hbr.org/2017/03/where-both-the-aca-and-ahca-fall-short-and-what-the-health-insurance-market-really-needs

No matter what the changes to ACA and the insurance marketplace, SoftCare’s EnrollmentPlus was designed by an Advisory Council of industry enrollment experts to facilitate the easy implementation of electronic enrollments from Employer Groups through Enrollment Vendors to Insurance Carriers. Call us for more details on click on https://softcare.cominsurance-plans/ on how EnrollmentPlus can fit into your electronic enrollment architecture

Mike Cobban

Mike.cobban@softcare.com

Director of Operations and Support

SoftCare Solutions | A Division of MTBC

There has been lot of talk on legislative proposals to allow Insurance Sales across state boundaries. As the old saying goes “that is fine but the devil is in the details”.  Part of the issue with cross-state insurance plans was addressed in the Employee Retirement Income Security Act of 1974 (ERISA) which allows companies with employees in multiple states to have minimum standards for retirement, health, and other welfare benefit plans.  This same concept is now being touted for individual mandates to the Affordable Care Act (commonly referred to as Obamacare).  Again, a great concept but it’s the business details that cause issues with anything. How would an insurer market, sell and maintain insurance in multiple states? Policy makes have broached the subject but really have not looked at how this will work in practice. The Commonwealth group has created an excellent article on the subject (see below) but in essence, it’s the economics and intricacies of an insurance company setting up a new provider network that is the key challenge.

Currently, out-of-state insurers have no current relationship or market share with in-state hospitals and physician practices; they would be forced to establish in-state networks that can compete with established in-state carriers.

The out-of-state insurers would be at an economic disadvantage as they would need to negotiate sufficiently low payment rates to enable them to offer competitively priced plans. Out-of-state insurers would only be able to offer plans with higher premiums than their competitors, producing no net benefit to consumers unless an insurer takes a great leap of faith to fully commit to a state. As profitability is incredibly important to any business, what smart insurance business executive would commit to selling insurance in another state without some guarantees of increasing profitability? There of course will be some states with sufficient populations to make this a good investment for insurance executives. How many and how prevalent it will be is to be determined

The Commonwealth fund has produced a great overview of the details of how allowing insurance sales across states work – see the attached link:

http://www.commonwealthfund.org/publications/explainers/2017/apr/selling-ins-across-state-lines

No matter what the changes to ACA and the insurance marketplace, SoftCare’s EnrollmentPlus was designed by an Advisory Council of industry enrollment experts to facilitate the easy implementation of electronic enrollments from Employer Groups through Enrollment Vendors to Insurance Carriers. Call us for more details on click on https://softcare.cominsurance-plans/ on how EnrollmentPlus can fit into your electronic enrollment architecture.

Years ago, Paul Harvey a great radio broadcaster would discuss stories presented as little-known or forgotten facts on a variety of subjects with some key element of the story (usually the name of some well-known person) held back until the end. The broadcasts always concluded with a variation on the tag line “And now you know the rest of the story.” I think a lot about this when I think of the discussions on the future of the ACA (more commonly known at Obamacare).

Much has been discussed about insurance carriers leaving Obamacare but just as significant is that some insurance brokers are opting out of some states Exchanges. Part of the reason is that some insurance companies have stopped paying brokers for signing up subscribers using the Exchanges. Some like BCBS of Texas have reduced broker commissions down to as low as 2.5% for brokers who cannot maintain the same number of enrollees as last year. This has created a disincentive to brokers to use exchanges for the induvial markets. The bottom line is that for consumers, the reduction of brokers in this marketplace is a bad thing as it hits the people who need the guidance of a professional broker to help them navigate their options.

According to previous CMS chief Kevin Counihan, he said, at least half of those enrolling in Obamacare plans were guided by a licensed broker or agent who can take a deeper look into finances and other variables to help consumers purchase the best plan for their situation and health issues.

Here is a nice overview of the situation written by John Ingle of the Times Record News (a part of the USA Today network).

http://www.timesrecordnews.com/story/money/business/2017/04/09/some-insurance-brokers-opting-out-obamacare-markets/100176698/

No matter what the changes to ACA and the insurance marketplace, SoftCare’s EnrollmentPlus was designed by an Advisory Council of industry enrollment experts to facilitate the easy implementation of electronic enrollments from Employer Groups through Enrollment Vendors to Insurance Carriers. Call us for more details on click on https://softcare.cominsurance-plans/ on how EnrollmentPlus can fit into your electronic enrollment architecture.