Health Practice Council

Health Practice Council Hightlights

• Provided numerous comments to the Department of Health and Human Services (HHS) on the new federal health reform law, the Affordable Care Act (ACA), related to its implementation including medical loss ratio reporting and rebates, rate review disclosure and justification of "unreasonable" increases, and the planning and development of state health benefit exchanges. As tasked in Section 1341 of the ACA, the Academy worked directly with HHS to discuss possible approaches to identifying high-risk individuals and determine reinsurance payments.
• Commented on a series of interim final regulations for several ACA provisions that took effect in 2010, including the creation of a temporary reinsurance program for early retirees; grandfathering provisions; the elimination of lifetime limits and restriction on annual limits; the elimination of preexisting condition exclusions for children younger than 19; the extension of dependent coverage to age 26; and provision of first dollar coverage for preventive services.
• Worked closely with the National Association of Insurance Commissioners (NAIC) and HHS to identify considerations for developing regulations on medical loss ratios reporting and rebates. Drafted multiple letters addressing the potential for disruption in the individual market, the potential inclusion of contract reserves, and statistical credibility. In addition, met with congressional staff, administration officials, and HHS and Office of Consumer Information and Insurance Oversight representatives to discuss various aspects of health reform implementation.
• Held a webinar on health care reform prior to the passage of ACA to give attendees an overview of the status of the pending reform measures. The webinar, which was co-sponsored by the Conference of Consulting Actuaries (CCA) and the Society of Actuaries (SOA), outlined some of the more significant differences between the House and Senate bills, and discussed the Academy’s involvement in the health care reform debate.
• Collaborated with the SOA on two new state-focused work groups—the Cancer Claims Cost Tables Work Group and the Long-Term Care Valuation Work Group. The Cancer Claims Cost Tables Work Group is in the process of evaluating, updating, and adjusting the 1985 NAIC cancer cost tables to account for the current level of benefits. The Joint Long-Term Care Valuation Work Group is in the process of making recommendations with respect to valuation morbidity tables for long-term care insurance.
• Contributed a series of articles to Contingencies covering international health care reform. The articles, which appeared in the January/February and September/October issues, discussed the health care systems in Germany, Japan, and Singapore.
• Developed two new practice notes. Actuarial Certification of Restrictions Relating to Premium Rates in the Small Group Market provides information for actuaries who develop actuarial certifications in the small group market. Practices for Preparing Health Contract Reserves provides information for actuaries who are required to prepare financial statements by illustrating some of the common approaches to this work.