Issues with insurance

With the effort to amend/repeal/replace the Affordable Care Act, we are currently one plan down and one to go. The first attempt to enact a new plan failed to come to vote in the House in March. This week a modified plan has surfaced that some are saying may move closer to being approved. In the below Article you will see some of the major provisions we expect to see vetted over the coming days.

Republicans have a new plan to repeal and replace Obamacare

Thursday, 20 Apr 2017 | 10:26 AM ET by Berkeley Lovelace Jr. – CNBC

Republican lawmakers have a new plan to repeal and replace Obamacare in a bid to bridge the gap between the House Freedom Caucus and moderates, according to a document obtained by CNBC.

A Freedom Caucus source told CNBC the changes to the health bill would secure 25 to 30 “yes” votes from the Freedom Caucus, and the new bill would get “very close” to 216 votes. The source said that 18 to 20 of those “yes” votes would be new.

Here is the document:

MacArthur Amendment to the American Health Care Act – 4/13/17

Insurance Market Provisions

The MacArthur Amendment would:

Reinstate Essential Health Benefits as the federal standard
Maintain the following provisions of the AHCA:

– Prohibition on denying coverage due to preexisting medical conditions

– Prohibition on discrimination based on gender

– Guaranteed issue of coverage to all applicants

– Guaranteed renewability of coverage

– Coverage of dependents on parents’ plan up to age 26

– Community Rating Rules, except for limited waivers

Limited Waiver Option

The amendment would create an option for states to obtain Limited Waivers from certain federal standards, in the interest of lowering premium costs and expanding the number of insured persons.

States could seek Limited Waivers for:

Essential Health Benefits
Community rating rules, except for the following categories, which are not waivable:
Gender
Age (except for reductions of the 5:1 age ratio previously established)
Health Status (unless the state has established a high risk pool or is participating in a federal high risk pool)

Limited Waiver Requirements

States must attest that the purpose of their requested waiver is to reduce premium costs, increase the number of persons with healthcare coverage, or advance another benefit to the public interest in the state, including the guarantee of coverage for persons with pre-existing medical conditions. The Secretary shall approve applications within 90 days of determining that an application is complete.

CNBC has reached out to the office of House Speaker Paul Ryan about the document.

Earlier this month, Freedom Caucus chairman Rep. Mark Meadows said the majority of caucus members will support the new bill if changes offered by the White House are included in the legislation, such as coverage waivers related to community rating protections.

In March, House Republicans pulled their first attempt at a repeal and replacement of Obamacare, dubbed the American Health Care Act, due in large part to opposition from both conservative and moderate Republicans.

The implementation of Health Care Exchanges has begun as part of the ramp up to the large changes in health care scheduled for 2014. The benefits of these websites will be selection and transparency of pricing for the individual and small business market. A couple of early sites are already available, including the one in New York City. This is a trend we will keep you updated on.

Wall Street Journal 11/16/2010 – By AVERY JOHNSON

Health-technology companies are hoping that the new state insurance “exchanges” required by the federal health-care overhaul will offer them big new growth opportunities.

EHealth Inc., an online insurance broker, has won two new government contracts for insurance websites, and has established a separate unit to go after a share of the exchange business. Benefitfocus Inc., which makes software designed for enrolling employees and others in health plans, says it is in talks with nearly 20 states to run their exchanges. Xerox Corp.’s ACS unit is circulating a white paper to states to make its case for integrating exchanges into Medicaid systems the company already runs.

At stake is some $4 billion a year in revenue, according to an estimate by HealthConnect Systems, a tech company that aims to compete for the new business. The Department of Health and Human Services raised the stakes in September when it awarded roughly $1 million each to 48 states and Washington, D.C., to help build exchanges. Last month the agency announced it would award additional grants to help develop the necessary information-technology systems.

Health-insurance exchanges are online marketplaces mandated by the law to promote competition and offer a way for the uninsured to find coverage. Many low-income consumers will be eligible for tax credits to help pay the premiums.

The exchanges must be up and running by 2014, but many states hope to beat that deadline. Utah and Massachusetts have exchanges that predate the overhaul law, but the exchanges are in the early planning stages in most states. That means it may be months, or even years, before major contracts go up for bid.

Setting up the exchanges may prove to be too complex for any one company. The 50 states could decide on as many different ways to run them.

Companies say that some of the challenges they may face include working with insurers to get plan and price information. The exchanges will likely need to be able to verify consumers’ eligibility for federal tax credits and for Medicaid, the program for the poor, which will be expanded by the health law. They may also need safeguards to protect personal-health data and payment information, the companies say, and they will need consumer-friendly interfaces.

Some of the potential competitors for the exchanges specialize in the consumer end of the business, while others are experienced in back-office functions, such as eligibility verification.

EHealth, of Mountain View, Calif., operates ehealthinsurance.com, a site the company says is the largest online vendor of health insurance. It sells plans from major insurers in each state, much the way Amazon.com sells books or music.

Last month, Florida picked EHealth and human-resources and benefits consultant Ceridian Corp. to set up Florida Health Choices, a website where small businesses can shop for coverage.

HHS tapped EHealth this summer to collect pricing and benefits data for healthcare.gov, a federal site where consumers can compare, but not yet buy, individual health plans.

EHealth recently established a separate government-services business focused on courting the states. “This could be a really, really good business,” says Gary Lauer, the company’s chief executive. “We are a tested solution that could work well for state governments.”

EHealth faces some tensions in leaping into the business. For starters, the exchanges will be competing with its existing website. Mr. Lauer says the exchanges might lure consumers online, but not all of them will want to buy there. It isn’t clear how much customer support the state exchanges might have. EHealth said it offers round-the-clock support and expects to sell subsidized health plans to people who qualify.

Insurance brokers like EHealth have little choice but to find new sources of revenue. Broker commissions are likely to be pinched by new rules which take effect next year, that require health plans to spend less on profits and overhead, including commissions. EHealth on its current system earns commissions averaging 10% to 11% on each sale —and more in the first year of a contract, says Mr. Lauer.

(more…)

A New Plan to Replace the ACA

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