Governor Cuomo Issues Executive Order Establishing New York State Health Insurance Exchange

Posted on April 12, 2012 under Uncategorized | Leave a comment

Today, April 12, 2012, Andrew Cuomo, Governor of New York State, issued an Executive Order (EO) establishing a statewide health insurance exchange. This action punctuates an over year-long debate in the state over how to authorize the creation of this new marketplace under the federal health reform law. The EO places the exchange inside the state Department of Health, which is charged with working with the state Department of Financial Services to take “all necessary steps to effectuate the Exchange, and expedite its ability to perform those functions necessary to carry out the requirements and serve the goals of the Affordable Care Act.” Regional advisory committees are another hallmark of the EO. These deliberative bodies, consisting of consumer representatives, small business representatives, health care providers, agents, brokers, insurers, labor organizations, and other stakeholders, will make recommendations – especially through their geographically distinct lenses – on the establishment and operation of the exchange.

Under the Affordable Care Act (the federal health reform law), each state must establish a statewide health insurance exchange by January 1, 2014. These new marketplaces within the broader health insurance market will facilitate enrollment into coverage for individuals and employees of participating small businesses. The federal government will fund completely the development and design of state exchanges, until 2015, when these entities must be financially self-sustaining. Estimates from the Urban Institute, in a study commissioned by New York State, note that the advent of the statewide exchange will spur reductions in health insurance premiums. Individuals are estimated to see their costs drop by 66 percent, and small businesses are expected to see premium relief of 22 percent. New York State has the option to open the exchange to large employers (firms with 100+ employees) beginning in 2017.

The Governor’s press release announcing the Executive Order, as well as the text of the Executive Order, can be found by clicking here.

Supreme Court Hearing of Health Reform Law Available Online

Posted on March 28, 2012 under Uncategorized | Leave a comment

The U.S. Supreme Court has concluded its hearing of six hours of oral arguments on various provisions of the federal health reform law. The case is seen widely as the most politically consequential cases since Bush v. Gore in 2000. A ruling from the Justices is expected to be issued in June, 2012, just in time for the heat of election season. Experts have noted that the ruling could come down in a variety of ways, including an inability to rule on the merits of the law because of the application of the Anti-Injunction Act, a 19th-century law that prohibits the courts from asserting an opinion on a tax law before a tax has actually been assessed.

In the meantime, transcripts and audio recordings of the oral arguments have been made available online and can be found in the below links.

Monday, March 26: Anti-Injunction Act (whether or not the Justices can rule on the law) – audio recording; transcript.
Tuesday, March 27: Individual mandate – audio recording; transcript.
Wednesday, March 28: Severability – audio recording; transcript.
Wednesday, March 28: Medicaid expansion – audio recording; transcript.

Health Reform in the Supreme Court: Everything You Need to Know

Posted on March 26, 2012 under Uncategorized | Leave a comment

Today, March 26, at 10:00am the United States Supreme Court will open oral arguments on various provisions of the health reform law. The entire law, in and of itself, is not being argued, but rather, four separate questions, each related to separate pieces of the law. The arguments will stretch six hours – an almost unprecedented amount by Supreme Court standards – over the next three days. Although the Supreme Court has decided not to allow television cameras in the courtroom, they will make recordings of the arguments available shortly after arguments conclude each day.

Here’s a brief guide to what the issues are and when the arguments will be made.

ANTI-INJUNCTION ACT

What it is: This issue revolves around the central question of whether or not the court can even issue a ruling on the Affordable Care Act (ACA). Under the Anti-Injunction Act, passed in 1867, a tax cannot be challenged until it has actually been assessed and someone has had to pay it. Penalties under the ACA don’t come into effect until 2015. This question provides the court with the opportunity to kick the can on the ACA until after this year’s elections, possibly diffusing its status as a front-line political issue.

When it happens: Monday, March 26, 10:00 – 11:30am

THE INDIVIDUAL MANDATE

What it is: The most hotly-contested of the challenges to the ACA, this provision of the law requires most Americans to carry health insurance coverage beginning in 2014. The legal question centers on whether or not Congress impose such a regulation under the Commerce Clause of the Constitution. Opponents of the law will argue that a decision not to purchase health insurance is economic inactivity and therefore cannot be regulated by the federal government. Supporters of the law will argue that everyone eventually will need health care services and thus the decision not to purchase health insurance indeed has economic effects. Experts have predicted that health insurance costs will skyrocket without a mandate because without one, balancing insurance risk pools will be a major challenge.

When it happens: Tuesday, March 27, 10:00am – 12:00pm

SEVERABILITY

What it is: Because of the complex political process Congress used to approve the ACA, a clause that would have kept intact the rest of the law from individual provisions that were invalidated by the courts went missing. The Supreme Court will hear arguments on whether the rest of the law should stand if they strike down either the individual mandate or the Medicaid expansion. The Department of Justice, representing the Obama administration, will argue that if the individual mandate is struck down, the guarantee issue and community rating provisions must go with it. Their chief contention is that the mandate is essential to making insurance markets work. Opponents of the law go one step further. They argue that if one provision falls, the entire law must go down with it.

When it happens: Wednesday, March 28, 10:00 – 11:30am

MEDICAID EXPANSION

What it is: The ACA expands Medicaid to cover everyone under 138% of the federal poverty level (FPL). Medicaid is run as a joint federal-state program, and states are arguing that this provision of the law is too expensive to implement and that the federal government is being coercive because the program is so deeply ingrained in the fabric of state budgets. Supporters of the law note that Medicaid is a voluntary program and that states can pull out whenever they wish.

When it happens: Wednesday, March 28, 1:00 – 2:00pm

————-

OTHER RESOURCES

AHIP has summarized in one chart the possible effects of repealing the individual mandate might have on insurance coverage projections. The New York Times Room for Debate page features various scholars commenting on the Supreme Court’s review of the ACA. The National Review features its own symposium on the court’s review. The New England Journal of Medicine has posted its version of an overview of the legal challenges.

A Busy Professional’s Guide to the Supreme Court’s Review of the Health Reform Law

Posted on March 19, 2012 under Uncategorized | Leave a comment

The Supreme Court of the United States is set to undertake its review of the federal health reform law next week. In an unprecedented move, the court will be devoting six hours – more than time given to a case than any other since 1966 – of oral arguments to it. At the heart of the case are four issues. The first, to be argued on March 26, is the applicability of the Anti-Injunction Act, an 1867 law which bars federal courts from ruling on the constitutionality of tax laws before payments have been made. On March 27, the court will hear arguments on the law’s central issue – the individual mandate and Congress’ power to regulate commerce and levy taxes. Arguments will conclude with on March 28 with 90 minutes devoted to the severability of the mandate from the rest of the law, and 60 minutes to state sovereignty in Medicaid expansion.

A plethora of resources have been published in attempts to simplify and digest the case for the general public. A few of these are below.

A New England Journal of Medicine Perspectives piece providing a broad overview of what’s at issue in the case is available here. A primer for the oral argument, courtesy of Kaiser Health News, can be accessed here. The New York Times primer is available here. And, the Supreme Court’s official page on its review of the law can be found here.

HHS Releases Final Exchange Rules

Posted on March 12, 2012 under Uncategorized | Leave a comment

The federal Center for Consumer Information and Insurance Oversight (CCIIO) today, March 12, 2012, published a final rule on health insurance exchanges under the Affordable Care Act. This next step in the regulatory process combines policies from two separate proposed rules that were released in the summer of 2012, and includes standards for the establishment and operation of an exchange, certification of health insurance plans to participate in exchanges, determination of an individual’s eligibility to enroll in an exchange, enrollment in qualified health plans (QHP), and employer eligibility to participate in the Small Business Health Options Program (SHOP) Exchange. Over 24,000 public comments were received in response to the proposed rules.

State flexibility is a hallmark of the 644-page final rule, allowing states plasticity to craft insurance marketplaces that fit local needs and trends.

Brokers, agents, and other third-party administrators will be allowed to work with states’ exchanges. Tim Hill, a CCIIO official, encouraged states to partner with third-party entities to help market and distribute exchange-based products and noted that states will be allowed to decide how their exchange compensates participating brokers and agents.

In light of the political challenges many states have faced in establishing their exchanges, the final rule offers states more time to set up their marketplaces. The reform law requires that the federal exchange be installed in states where the exchange does not demonstrate complete readiness by Jan. 1, 2013. The long-awaited rule, however, allows for “conditional approval” of an exchange if it is “advanced in its preparation” by Jan. 1, 2013 and is likely to be fully ready by Oct. 1, 2013. And, states that aren’t ready for the 2014 launch date can apply to operate their own exchange in later years.

Small Business Health Options Program (SHOP) exchanges, the arm of a state’s exchange serving small businesses, will allow employers multiple options in how they offer employees coverage. Employers can select a level of coverage from which employees can choose a plan. They can also offer their employees the option of choosing any plan from the exchange that they would like, allowing them the flexibility to select a plan that fits their needs and budget. The rule requires the exchange to provide participating employers with a single bill and the ability to pay using a single check. Minimum participation rules will be met through overall coverage in any SHOP plan rather than participation in any one QHP.

The final rule preserves states’ ability to determine the size of small businesses that can participate in SHOP. States can allow firms with either 1 to 50 or 1 to 100 employees to participate until 2016. Beginning in 2016, all firms with fewer than 100 employees will be allowed in SHOP. States have the option to expand it even further in 2017 or later.

CCIIO officials noted on a conference call that specifics regarding how a federal exchange might work in states that aren’t ready or aren’t willing to operate their own exchange are still being worked on.

The HHS exchange Fact Sheet can be found here. The final rule can be found here.

Hospitals Make Progress in Eliminating Early Elective Deliveries: Good News, But More Work Needs to Be Done, Says Hospital Watchdog Group

Posted on February 1, 2012 under Uncategorized | Leave a comment

The Leapfrog Group, an employer-driven hospital quality watchdog, recently released survey data from participating hospitals on the rate of elective, pre-term deliveries in U.S. hospitals. Pre-term deliveries, specifically elective cesareans or induction prior to 39 weeks gestation, are consistently shown to lead to worse health outcomes for mothers and babies, as well as higher costs. The 2011 report shows that 39% of participating hospitals had pre-term delivery rates at or below 5%, compared to 30% of participating hospitals in 2010. While it is promising that pre-term delivery rates were reduced from the previous year, rates remain high, and might be exacerbated by economic benefits which incentivize early medical intervention when it is not medically necessary. Furthermore, there is a range of 5% – 40% pre-term delivery rates among hospitals, demonstrating the need for consistent clinical guideline implementation and support across hospitals and health systems.

NEBGH is a strong proponent of the Leapfrog Group and the work it is conducting examining the relationship between how medical services are reimbursed and corresponding patterns of care. NEBGH is the “regional roll-out” for Leapfrog in New York and Connecticut, and as such, asks hospitals to fill out the Leapfrog survey every year. Since Leapfrog began focusing on this issue, pre-term delivery has become a priority area for the National Priorities Partnership and the Department of Health and Human Service’s Partnership for Patients campaign. The work of the Leapfrog Group is further demonstrating that eliciting clinical and health claims data from employers, purchasers, and providers highlights both shortcomings and strengths of the healthcare delivery system. Only through bringing such issues to our attention can purchasers get better value from health care, leading to improved outcomes for their employees and lower costs.

To view hospital-level data, The Leapfrog Group’s report can be viewed at www.leapfroggroup.org/tooearlydeliveries

Catalyst for Payment Reform’s (CPR) toolkit designed to aid employers, health plans, and purchasers influence payment reform

Posted on January 31, 2012 under Uncategorized | Leave a comment

Catalyst for Payment Reform (CPR), a nonprofit organization composed of various health care purchasers, has created a toolkit with model health plan request-for-information (RFI) and contract language. NEBGH is a strong supporter of CPR’s efforts to increase the quality and reduce the costs of healthcare. Geared towards employers’ evaluation of health plans during an RFI process, the toolkit provides employers with model contract language to use when formalizing their expectation that health plans implement innovative payment models, delivery models, and quality metrics. CPR’s toolkit also provides purchasers with detailed reviews of available payment and delivery models; key market attributes for consideration of payment reform designs; common vocabulary; and descriptions of prominent payment models, delivery systems, and general principles. For more information and to download CPR’s toolkit, visit http://www.catalyzepaymentreform.org/

Essential Health Benefits Guidance Released; States Provided Flexibility to Determine Benchmark

Posted on December 16, 2011 under Uncategorized | Leave a comment

On Friday, December 16, 2011, the US Department of Health & Human Services (HHS) released long-anticipated regulatory guidance – in the form of a pre-rule bulletin – related to the reform law’s essential health benefits package. Under the law, health plans offered in the individual and small group markets, both inside and outside of state health benefit exchanges, offer a comprehensive package of items and services, known as “essential health benefits.” Essential health benefits must include items and services within at least 10 categories set out in the statute.

Since the reform bill passed in March 2010, observers have hotly debated the impacts that the minimum essential health benefits package would have on coverage costs and comprehensiveness for plans sold in the individual and small group markets. One pressing issue is that States are required to subsidize the costs of any mandated benefits that go above and beyond the federal floor for individuals receiving premium subsidy support in exchanges. An advisory report published by the Institute of Medicine in the fall of 2011 recommends that the ultimate minimum essential benefits package rightly balance costs and comprehensiveness of coverage.

Instead of setting a national essential health benefits standard, as was expected by many observers, this pre-rule bulletin proposes giving “states the flexibility to select a plan that would be equal in scope to the services covered by a typical employer plan in their state.” This approach would allow states to select an existing plan to serve as the “benchmark” for items and services to include in the essential health benefits package.

For 2014 and 2015, States would choose one of the following health insurance plans as their benchmark:

-One of the three largest small group plans in the state;

-One of the three largest state employee health plans;

-One of the three largest federal employee health plan options;

-The largest HMO plan offered in the state’s commercial market.

HHS notes in their press release, “the benefits and services included in the health insurance plan selected by the state would be the essential health benefits package. Plans could modify coverage within a benefit category so long as they do not reduce the value of coverage.”

In the instance that a State does not make a benchmark choice, HHS proposes that the default benchmark will be the small group plan with the largest enrollment in the State. This option would include state-mandated coverage in that plan.

The HHS press release can be found here.

The pre-rule informational bulletin can be found here.

A policy brief, published by HHS, that compares benefits in small group products and State and Federal Employee Plans is here.

HealthPass New York President & CEO on NY1 Segment

Posted on December 15, 2011 under Uncategorized | Leave a comment

HealthPass New York President & CEO Vincent Ashton recently appeared on the television program Inside City Hall, which airs weekdays on NY1. Alongside Matt Grove, a small business owner from Utica, New York, Mr. Ashton discussed how health insurance exchanges benefit small businesses and the urgent need for the state legislature to enact a bill authorizing the creation of a state-based exchange as required under the Affordable Care Act.

The complete interview can be found here.

Survey Notes Small Business’ Perspectives on Health Insurance Exchanges

Posted on December 15, 2011 under Uncategorized | Leave a comment

A recent survey of 300 New York small business owners demonstrates overwhelming support for a robust health insurance exchange for small employers in New York. The survey, commissioned by NEBGH subsidiary HealthPass New York, a non-profit commercial health insurance exchange, and conducted by Hudson TG, demonstrates small employers’ strong support for a solution that achieves the twin goals of enabling them to provide their employees with more health care coverage options while also simplifying health insurance purchasing and administration.

While high costs are often cited as their most pressing issue, over half of the respondents note the great potential to refocus their resources to more fully achieve their primary business goals if they could spend less time dealing with health benefit issues. The vast majority (84%) of respondents think that the type of small employer exchange – one that allows for employee choice of coverage, defined contribution approaches and a robust set of administrative services – outlined in pending state exchange authorizing legislation is a “good idea.” Moreover, 76 percent indicated that they would consider using such an exchange when offering health care coverage to their employees. Even more striking, 60 percent of businesses that do not currently offer health benefits say they are more likely to offer benefits if a health exchange is available to them. It’s apparent that choice is important to small businesses too. Fully 68 percent indicated that providing their employees a choice of different health care plans is an important consideration when thinking about health benefits.

A synopsis of the survey results can be found here.