Academy Activities

The Academy’s Risk Sharing Work Group submitted a letter Dec. 22 to the U.S. Department of Health and Human Services (HHS) in response to a proposed rule on benefit and payment parameters for 2016. Comments were related to the risk adjustment, reinsurance, and risk corridor components; the letter also requested clarification on provisions related to benefit coverage and rate review and disclosure.

On Jan. 7, the Academy’s Life Capital Adequacy Committee, Property and Casualty Risk-Based Capital Committee, and Health Solvency Work Group sent a letter to the NAIC in response to questions from an Operational Risk (E) Subgroup call held on Dec. 4.

Legislative/Regulatory Updates

President Obama on Dec. 16 signed into law an omnibus spending bill that includes a provision to prohibit the Centers for Medicare and Medicaid Services (CMS) from using appropriated or transferred funds to make Affordable Care Act (ACA) risk corridor payments. The Consolidated and Further Continuing Appropriations Act of 2015 continues funding of the government through September 2015.

On Dec. 19, the Center for Consumer Information and Insurance Oversight published a draft letter providing guidance to issuers who want to offer qualified health plans in the federally facilitated exchange or the Small Business Health Options Program.

The departments of Health and Human Services, Treasury, and Labor published a proposed rule related to changes to the summary of benefits and coverage and the glossary for coverage in the group and individual markets under the ACA. Comments on the proposed rule are due by March 2.

The U.S. House passed legislation Jan. 8 that would reduce the number of employers subject to the ACA employer mandate by changing the definition of full-time employment from 30 hours per week to 40 hours. The Congressional Budget Office has stated that over the next 10 years (2015-2025), such a change would increase the budget deficit by $53.2 billion, reduce the number of people receiving employer-based health insurance coverage, and increase the number of individuals who are uninsured. The U.S. Senate is expected to vote on this legislation soon; President Obama has already issued a veto threat.

In the News/Media Activities

Senior Health Fellow Cori Uccello provided an actuarial perspective to the subscriber-only publication Inside Health Insurance Exchanges after Congress enacted legislation to make the ACA’s risk corridor program budget-neutral. Uccello noted that uncertainty persists because online exchange enrollment has yet to reach equilibrium, and the composition and health spending of the entire market may still be unknown. “When setting premiums, therefore, insurers need to consider not only the risk profile of enrollees in their own plans, but also the risk profile of enrollees in the market as a whole,” Uccello said.

Additionally, Health Affairs Blog ranked Uccello’s piece “How Will 2015 Health Insurance Premiums Compare to 2014?” among the website’s top 15 most-read posts in 2014.

The Medicaid Work Group’s recent letter to CMS on the potential impact of high-priced breakthrough therapy designated drugs on rate setting was the basis of a Modern Healthcare story. It quotes the Academy’s comment letter to CMS, saying, “A new therapy ... has the potential to diminish the ability of the actuary to accurately project future expenses from historical experience because of the significant change in practice patterns and costs that such new treatments can create.” The piece was also published in the subscriber-only publication American Health Line.

BenefitsLink Health & Welfare Plans Newsletter reported on the letter that the Academy’s Risk-Sharing Work Group sent to HHS regarding the risk-sharing components of a proposed rule on benefit and payment parameters for 2016.

Upcoming Health Care Reform Events

Medicare and Medicaid: The Next 50 Years
Conference: Jan. 28-29, National Press Club, Washington (fee charged)
Sponsor: National Academy of Social Insurance

2015 Annual Medicare Congress
Conference: Feb. 3-5, New Orleans Marriott Downtown at the Convention Center (fee charged)
Sponsor: Medicare Congress

2015 Intercompany Long-Term Care Insurance Conference
Conference: March 22-25, The Broadmoor Hotel, Colorado Springs, Colo. (fee charged)
Sponsor: ILTCI

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