HealthCheck, Spring 2020
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Spring 2020
VOL 11 | NO 1 |
Welcome to the New HealthCheck
This is the first “new” HealthCheck as a quarterly publication. HealthCheck began as an Academy publication 10 years ago in January 2010, to provide additional health reform coverage amid the debate and eventual passage of the Affordable Care Act (ACA). The change—from a monthly to a quarterly issue—aligns HealthCheck with the Academy’s other practice-area quarterly publications, and will allow for a more in-depth look at topics of interest, such as the coronavirus pandemic in this inaugural issue.
Academy’s FAQs on COVID-19 Offer Pandemic Perspective on Health Insurance, Health Care Spending
As the coronavirus pandemic continues to spread, its effects on U.S. health care spending and health insurers for 2020 and beyond are uncertain, according to the Academy’s “FAQs on COVID-19 and Its Effects on Health Spending and Health Insurance,” published in late March.
Factors affecting health spending include the ultimate coronavirus hospitalization rate, COVID-19 treatment costs, and the degree to which increased spending for patients with COVID-19 will be offset by deferments or cancellations of nonessential services. These factors can vary by insurance market and geographic area.
“The pandemic and policy responses to it are evolving rapidly, bringing uncertainty to how total national health spending will be affected and how costs of care for 2020 will compare to what insurers anticipated when they set premium rates for the year,” said Academy Senior Health Fellow Cori Uccello. “That uncertainty also applies to 2021 health spending projections, even as insurers are currently developing 2021 premiums.”
If COVID-19-related health care costs are concentrated in 2020, then 2021 health spending might be affected only minimally—for instance, due to an increase in nonessential services that were deferred from 2020 or from any newly available virus vaccines. However, if COVID-19 incidence and related costs are expected to continue into 2021, premiums for 2021 could be affected as well.
Additionally, the FAQs address potential results of pandemic-related outlays on the solvency of private health insurers, as well as the potential impact of special enrollment periods. The Health Practice Council plans to update the FAQs as new information becomes available and to add FAQs regarding the effects of the virus on the Medicaid and Medicare programs.
Academy Webinar Will Discuss COVID-19, Rate Filings
The Academy is planning to host one or more webinars as needed to discuss the impact of COVID-19 on actuarial practice areas. The Health Practice Council is in the process of planning a webinar with state and federal regulators to discuss the potential effects of the coronavirus pandemic and the prospective impact of COVID-19 on 2021 rate filings and 2020 reporting requirements for individual and small group plans. A cross-practice webinar is scheduled for April 28; registration will open soon.
Academy Webpage Offers Coronavirus Pandemic Resources
The Academy has created a webpage with resources for the ongoing coronavirus pandemic. The page includes resources such as links to the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO), the Centers for Medicare & Medicaid Services (CMS) regulatory activity and other legislative and regulatory actions, pertinent articles, and more.
The latest updates include COVID-19 stakeholder calls via CMS, and a link to H.R. 748, the CARES Act. The Academy will continue to add resources to this freely available webpage as more information becomes available. Visit the webpage at www.actuary.org/coronavirus.
Sections include federal rules and regulations, from CMS and other agencies such as the IRS; legislative actions, including multiple pieces of coronavirus-related legislation; projections and treatment cost estimates, which include expert analyses from a variety of sources; data trackers such as the widely cited Johns Hopkins coronavirus / COVID-19 map and tracker; CDC and WHO resources; major media outlets and academic articles; NAIC resources; and Academy and other actuarial resources.
Health Volunteers Engage With Lawmakers, Policymakers During Annual ‘Hill Visits’
Academy Health Practice Council volunteers visited federal lawmakers and policymakers in late February for their annual “Hill visits” on Capitol Hill in Washington, D.C.
Past President Tom Wildsmith (center) prepares with Academy health volunteers for the Hill visits
More than 20 volunteers visited nearly two dozen congressional offices and federal agencies Feb. 27–28, including CMS/CCIIO, the Department of the Treasury, the Government Accountability Office, the Congressional Budget Office, and the Congressional Research Service.
In conjunction with the meetings, the Academy released three issue briefs—on Medicaid costs, health care costs (smarter spending), and long-term care—to discuss during their visits.
Volunteers discussed key health issues including health care delivery, Medicare and Medicaid, telehealth, long-term care, individual and small group markets, prescription drugs, surprise billing, and other pertinent health care related topics.
“With so many health policy issues being debated in Washington, D.C., we’re pleased to have had constructive discussions on a range of topics with policymakers and agencies,” said Audrey Halvorson, Academy vice president, health. “The Academy’s reputation as a nonpartisan source of information is highly valued on Capitol Hill and by federal regulatory agencies.”
Comment Deadline on Actuarial Memorandum Practice Note Extended Until June
In light of the coronavirus pandemic, the Academy has extended the comment period for the exposure draft of the Actuarial Memorandum Practice Note until June 15. Comments had previously been due in March.
The Actuarial Memorandum Practice Note Work Group published the exposure draft in January to provide information that can be useful for appointed actuaries dealing with challenges of producing an Actuarial Memorandum in support of the Actuarial Opinion filed as part of the Health Annual Statement Blank, which is often referred to as the Health Blank or the Orange Blank. Comments can be submitted to health@actuary.org.
Uccello Moderates Health Conference Session
Academy Senior Health Fellow Cori Uccello co-moderated a plenary session at a March 5 health conference sponsored by the National Academy of Social Insurance, “Healthcare Coverage and Costs: Assessing Medicare-Based Approaches.”
Uccello co-moderated “The Current Health Care Reform Landscape,” in which panelists looked at drivers of the current health care reform debate; why Medicare is viewed as a potential platform for expanding coverage; current policy issues, including the persistent problems of uninsurance and underinsurance, affordability challenges, health disparities, and inequities; and the rising cost of health care in the United States.
Uccello also was co-chair of the National Academy of Social Insurance study panel that released a report the week of the meeting, Examining Approaches to Expand Medicare Eligibility: Key Design Options and Implications.
Subcommittee Comments on Health Bond Factors
The Health Solvency Subcommittee submitted a response letter to the NAIC Health Risk-Based Capital (HRBC) Working Group regarding its request to provide the health bond factors over a range of additional time horizons—spanning one to five years.
Annual Meeting to Feature Historian Michael Beschloss, Political Analyst Charlie Cook
Registration is open for the Academy’s scheduled 2020 Annual Meeting and Public Policy Forum, which will feature two highly respected speakers who will weigh in on this year’s presidential election, just days after it occurs.
The Annual Meeting and Public Policy Forum will be held Nov. 5–6 at the Fairmont Hotel in Washington, D.C. Continuing education credit will be available. Discounted early registration rates are now available—register today.
Registration Open for LHQ Seminar
Registration is open for the Academy’s 2020 Life and Health Qualifications Seminar. This annual seminar sells out every year because it delivers the highest-quality and most efficient way to obtain any needed basic education or relevant continuing education (CE) credit necessary to qualify to issue actuarial opinions for either the NAIC Life and Accident & Health (A&H) Annual Statement or the NAIC Health Annual Statement. The seminar is scheduled for Nov. 9–12 at the suburban Washington, D.C., Crystal Gateway Marriott in Arlington, Va. (new location for this year). Register now and save—discounted registration rates are now available.
Register With Confidence for Academy Events: New Cancellation Policy
The Academy is monitoring the ongoing coronavirus pandemic situation and adhering to the guidelines surrounding in-person events and large gatherings. While we are moving forward with our fall event schedule—including the marquee Annual Meeting and Public Policy Forum—we also want our members to be able to register with confidence knowing it’s important to you, and the Academy, to try to anticipate a return to normalcy. The Academy now has cancellation policies in place to accommodate any necessary change to your registration resulting from a continuation of the current pandemic situation.
So you can rest easy as you register for our fall events—we look forward to seeing you in person later this year. You can find the cancellation policy for the annual meeting registration page here and the LHQ Seminar here.
ICYMI: Listen to Secretary-Treasurer Cathy Murphy-Barron on ‘Actuary Voices’
Murphy-Barron The latest installment in the Academy’s “Actuary Voices” podcast series features a conversation with Academy Secretary-Treasurer and former Health Practice Council Vice President Cathy Murphy-Barron. She enthusiastically and joyfully shares her personal experience as an actuary, in conjunction with our focus on Women’s History Month. “My advice to girls in school is don’t let anyone tell you that girls aren’t good at math,” Murphy-Barron said. Subscribe to “Actuary Voices” via iTunes, Spotify, or other podcast services. Click here to listen now.
Following is an update of key federal health-related legislative, regulatory, and judicial activity.
President Trump signed into law a $2.2 trillion emergency relief bill on March 27 in response to the economic impact of the coronavirus pandemic. H.R. 748, the CARES Act, contains appropriations measures aimed at addressing the financial impacts felt by the American people and businesses, as well as measures to increase funding for hospitals, telemedicine, and state Medicaid programs, among other provisions. Specific spending levels can be found in the Academy alert published on the date of passage.
This was the third piece of legislation Congress has passed in response to the coronavirus pandemic. President Trump also signed into law H.R. 6201, the Families First Coronavirus Response Act, which established paid family and sick leave programs and provided coverage of diagnostic testing for COVID-19 with no patient cost-sharing, including for uninsured patients. Additionally, Congress passed H.R. 6074, the Coronavirus Preparedness and Response Supplemental Appropriations Act, which provided $8.3 billion in emergency funding for manufacturing medical supplies, and grants to state and local governments to address the crisis.- The Centers for Medicare & Medicaid Services (CMS) issued new coronavirus-related guidance in several areas including telehealth, hospital data-sharing, advanced payments to Medicare providers, and others. CMS has created a specific webpage that aggregates all of its COVID-19 guidance and regulatory changes as a tool to allow providers, parers, and consumers to follow CMS’ rapidly evolving response to the pandemic.
- As of April 7, CMS has approved Medicaid Section 1135 waivers to 48 states, as well as the District of Columbia, in response to the COVID-19 pandemic. The waivers grant states more flexibility in temporarily modifying or suspending requirements for their Medicaid programs. A full list of the states granted Section 1135 waivers can be found here.
- The IRS issued guidance on March 11 related to high-deductible health plans (HDHP) to facilitate the nation’s response to the coronavirus pandemic. The guidance provides that HDHPs can cover COVID-19-related testing and treatment without jeopardizing their HSA-qualified status. Additionally, an individual covered by an HDHP responsible for COVID-19 testing or treatment may continue to contribute to a health savings account (HSA).
- The U.S. Supreme Court announced March 2 that it would rule on the constitutionality of the individual mandate of the Affordable Care Act (ACA). In December, the 5th U.S. Circuit Court of Appeals issued a decision in Texas v. Azar, ruling the individual mandate of the ACA unconstitutional. A coalition of 20 Democratic state attorneys general petitioned the decision to the Supreme Court, requesting the court fast-track the case for appeal by June. That request was denied in January, but the Supreme Court has since agreed to take up the case. The court’s current plan, according to announcement, is to consider the case during its next term, beginning in October, and a one-hour oral argument may be scheduled prior to the November election. A decision on the case would likely not be issued, however, until spring or summer 2021.
- The Department of Health and Human Services issued two final rules on March 9 to provide secure patient access to health data. The rules, in support of the administration’s MyHealthEData initiative, strengthen health care data-sharing policies, requiring both public and private entities to share health information between patients and other parties to provide security and transparency. The first rule, Unleashing Innovation and Patient Access, establishes security requirements to support patient access and control of their electronic health information. The second rule, Addressing Interoperability and Information Blocking, identifies the reasonable and necessary activities that do not constitute information blocking while establishing new rules to prevent information-blocking practices by health care providers and additional health care information personnel.
In the News
The Wall Street Journal cited the Academy’s research on the potential health care savings of reference pricing in an editorial on public policy approaches to controlling health care costs.
Health Leaders, Advisor Magazine, Managed Healthcare Executive, and Health Plan Weekly reported on the Health Practice Council’s FAQs on COVID-19 and the potential effects on health spending, and quoted Senior Health Fellow Cori Uccello. Politico Pro (subscriber-only) cited the Academy’s analysis in its reporting on coronavirus-related legislation then being considered by Congress, and since enacted as the CARES Act.
Health Plan Weekly cited the Academy’s September 2019 issue brief on surprise medical billing in a story on the momentum some legislation to address the issue has in Congress.
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