Academy Activities

On Nov. 5, the Health Practice Council sent a letter to members of Congress outlining potential adverse consequences of delaying the Affordable Care Act (ACA) individual mandate and/or extending its open enrollment period.

In early November, the Health Practice Financial Reporting Committee released a new issue brief that provides an overview of ACA provisions that may create some uncertainty on future financial statements—the premium stabilization programs, new taxes and fees, advanced payments, and existing actuarial liabilities.

In late October, the Health Solvency Work Group submitted responses to questions from the National Association of Insurance Commissioners’ Health Risk-Based Capital Working Group regarding the work group’s model that examines expenses within the context of business concentration risk.

On Oct. 18, members of the Academy’s Health Care Receivables Factors Work Group participated in a webinar to discuss the Exhibit 3A instructions, which are new for the 2013 NAIC’s Health Annual Statement. The panelists provided an overview of health care receivables, discussed the purpose of the new exhibit, and shared examples with cross references to Exhibit 3 and the Underwriting & Investment Exhibit Part 2B.

Legislative and Regulatory Updates

Sen. Joe Manchin, D-W.Va., introduced legislation on Nov. 7 delaying the implementation date of the individual mandate provision in the Affordable Care Act (ACA) from Jan. 1, 2014, to Jan. 1, 2015. The legislation, S 1671, was introduced because of the problems experienced so far with ACA implementation. A one-year delay in the requirement for individuals to acquire health insurance or face a financial penalty would allow Congress the time it needs to address the ACA problems and allow consumers more time to determine their own coverage.

The Department of Health and Human Services released final rules on Oct. 30 addressing financial integrity and oversight standards of health insurance exchanges under the ACA. The rule establishes standards for special enrollment periods, vendors that may conduct enrollee satisfaction surveys on behalf of qualified health plan issuers in the exchanges, and issuer participation in a federally facilitated exchange. The rule also makes certain amendments to definitions and standards related to the market reform rules. The final rule will be effective Dec. 30.

Two pieces of legislation seeking to allow individuals to maintain their existing health care coverage were recently introduced. On Oct. 30, Rep. Ron DeSantis, R-Fla., introduced HR 3406, which would continue grandfathered group health plans or individual health insurance policies. It also would allow family members of policy holders to join any such coverage maintained by the policy holder and allow new employees to join group health plans. On Nov. 4, Sen. Mary Landrieu, D-La., introduced S 1642, a companion bill to HR 3406.

Rep. Darrell Issa, R-Calif., introduced legislation on Oct. 23 to modify the Federal Employees Health Benefit program (FEHBP) to allow for the enrollment of non-federal employees. The legislation, HR 3319, also authorizes employers to offer coverage for their employees through this program, as well as authorizing employers to make a contribution toward the cost of the program. The legislation also allows for the plan purchased under the FEHBP to be qualified as one purchased through the exchanges, for purposes of fulfilling the individual mandate portion of the ACA.

On Oct. 22, Sen. Jeanne Shaheen, D-N.H., sent a letter to President Barack Obama calling for an extension of the open enrollment period for health exchanges. Citing continuing problems with signing up for insurance through the Healthcare.gov web site, Sen. Shaheen called on President Obama to extend the enrollment period past March 31, 2014, and explain how the “individual responsibility penalty will be administered and enforced” in light of the web site’s difficulties.

In the News

A U.S. News and World Report story “Obama 'Sorry' Some People Losing Health Coverage” mentions an Academy letter warning that delaying the mandate or extending the open-enrollment period could increase health insurance premiums in 2015. The Academy’s stance was covered in several other articles on the issue:

• “Delaying Obamacare Mandate May Mean Higher Rates: Actuaries,” CNBC;
• “Obamacare Individual Mandate Delay Could Be Costly, Actuaries Say,” Wall Street Journal Blog;
• “Dem-Backed Bill Delays O-Care Mandate,” The Hill;
• “Obamacare Individual Mandate Delay Could Be Costly, Actuaries Say,” Marketwatch;
• “Would delaying Obamacare give the market a heart attack?” Yahoo! Finance/Fox News Videos;
• “Delaying Obamacare Mandate May Mean Higher Rates,” Yahoo! Finance/CNBC;
• “Actuaries Warn Against Individual Mandate Delay,” Modern Healthcare;
• “ICYMI—Actuaries: Delaying Individual Mandate Would Disrupt Coverage, Increase Costs for Consumers,” AHIP Coverage;
• “Actuaries: Individual Mandate Delay Would Hike Premiums, Increase Deficit, Hurt Plans,” Inside Health Policy;
• “Humana Exec Predicts Obamacare Open Enrollment Extension,” Kaiser Health News; Washington Post; Government Health IT; Oxford (Ohio) Press;
• “Obamacare Woes Abound in Washington,” Helicopter Association International;
• “Wonkbook: Seven Reasons Obamacare Isn’t Facing a ‘Death Spiral,’” Washington Post;
• “Actuaries Warn Against Mandate Delay, Enrollment Extension,” Politico Pulse;
• “Actuaries Warn: Delaying Health Reform’s Individual Mandate Would Raise Premiums and Add to Ranks of Uninsured,” Center on Budget and Policy Priorities “Off the Charts” blog;
• “Top Health Insurer Anticipates Extension of Obamacare Open Enrollment,” National Review;
• “Actuaries Warn About Extending Open Enrollment Period,” InsuranceNewsNet;
• “Actuaries: ACA Delays Would Cause Chaos,” The Hill;
• “Actuaries Warn of Consequences of Extending ACA Open Enrollment or Delaying Individual Mandate,” Bloomberg BNA Health Care Blog.

An article in BenefitsPro talks about Academy recommendations for new final regulations for the Mental Health Parity and Addiction Equity Act of 2008.

The Academy is mentioned in the Fox News segment: “Lessons to be Learned from Obamacare's Impact on Elections.”

The Hawaii Reporter mentions Academy statistics on cost savings from consumer-directed plans in “A ‘Direct’ Way to Lower Health Costs.”

Senior Health Fellow Cori Uccello is quoted in the Washington Post article “Why Insurers Cancel Policies, and What You Can Do When It Happens

A piece called “Many Young Single Women Will See Premiums Rise” in the National Review Online cites a Contingencies article on ACA and young adults.

Upcoming Events

Quality Care: Getting More Bang for the Buck?
Briefing: Nov. 15
Sponsor: The Alliance For Health Reform

The Importance of Big Data to the L&H Insurance Industry—Improving Our Use of Structured and Unstructured Data Sources
Webinar: Nov. 15
Sponsor: International Actuarial Association Health Section (fee charged)

Winning the Oregon Medicaid Lottery: A Case Study on Medicaid's Effect on Utilization, Finances, and Health Outcomes
Webinar: Dec. 4
Sponsor: American Academy of Actuaries

Exchange Conference
Conference: Dec. 12, Omni Shoreham Hotel, Washington, Sponsor: America’s Health Insurance Plans (fee charged)

For a complete listing of upcoming and recent health care reform events click here.