HealthCheck, Spring 2022

HPC Holds Annual ‘Hill Visits’ With Federal Health Policy Stakeholders

SchmitzHealth Practice Council (HPC) volunteers and Academy staff virtually visited the offices of federal policymakers and regulators March 10–11 during their annual health “Hill Visits.” A number of key issues for both the HPC and policymakers were discussed, including health equity, COVID-19 and the implications for health care utilization and spending, insurance coverage, long-term care, Medicare sustainability, payment and delivery reform, and climate change implications for health.

Over two dozen volunteers took part in about 20 meetings with majority and minority U.S. House and Senate leadership and committee staff members, and with representatives from the Biden administration and key agencies including the U.S. Treasury Department, Labor Department, the Congressional Budget Office, Congressional Research Service, the Centers for Medicare & Medicaid Services, and the Government Accountability Office.

Academy volunteers offered perspectives on a variety of health insurance issues and heard from stakeholders about their priorities for 2022 and into next year.

“It was clear from our visits that the Academy is held in very high regard by the various congressional agencies, committees, and the Biden administration,” said Al Schmitz, the Academy’s health vice president. “Those we met with were very appreciative of our perspective and willingness to meet with them, and we engaged on a wide variety of the Health Practice Council’s key 2022 priorities including health equity, Medicare sustainability, payment and delivery reform, and long-term care.”

Meetings also included those with Senate  Finance Committee, House Ways & Means Committee and with health policy staff members of House Speaker Nancy Pelosi and Minority Leader Kevin McCarthy.

“It’s always good to hear from the Academy—we really value your high-quality work,” one congressional staff member said; another staffer opined that “the actuarial perspective is critically important.”

Hospital Price Issue Brief Released

In conjunction with the Hill Visits, the HPC’s Health Care Delivery Committee released a new issue brief, Implications of Hospital Price Transparency on Hospital Prices and Price Variation, which examines factors contributing to hospital pricing and price variation and the impacts on consumers and insurance payers, that was discussed during the visits.

Key points include:

• Price transparency may be a necessary but not sufficient mechanism to lower hospital prices and health care spending;
• Whether price transparency leads to increased competition, lower hospital prices, and lower variation in prices depends on several factors;
• Consumers might not have an incentive to seek lower-priced care unless their out-of-pocket costs are tied to prices and referring providers also have an incentive to refer patients to lower-priced providers; and
• It is not yet understood how price transparency will impact health care expenditures overall and consumer affordability.

JamesJames Participates in Health Policy Forum

Health Equity Work Group (HEWG) Chairperson and Academy Board member Annette James took part in “Health Policy Roundup: Recent Trends in Coverage Enrollment and Affordability,” an online forum hosted Jan. 21 by the Alliance for Health Policy, in which she focused on what health actuaries do, including premium development, current trends in the health “ecosystem,” and the considerable work of the HEWG.

Academy Engages on New Colorado Insurance Discrimination Law

Academy President Maryellen Coggins sent a letter to Colorado Insurance Commissioner Michael Conway on that state’s law to protect consumers from unfair discrimination in insurance enacted last year.

The statute prohibits unfair discrimination based on certain personal characteristics—race, color, national or ethnic origin, religion, sex, sexual orientation, disability, gender identity, or gender expression—in any insurer practice. The law is intended to regulate insurers that use external consumer data and information sources, algorithms, and predictive models.

“It is our belief that we can continue to provide useful professional input as you work on the implementation of [the regulations],” Coggins wrote.  The letter addressed general considerations, across practice areas, on implementing the law as well as particular issues involving health insurance.

Stakeholder Engagement Session

During the implementation process, the Colorado Division of Insurance (DOI) intends to hold stakeholder engagement meetings The DOI has held its first session, chaired by Conway, on life underwriting  considerations in which Academy Life Underwriting and Risk Classification Work Group chairperson, Sue Bartholf presented.

HPC Groups Comment on Proposed 2023 NBPP

The HPC’s Individual and Small Group Markets Committee, Risk Sharing Subcommittee, and Health Equity Work Group submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS) on CMS’ proposed rule for the 2023 Notice of Benefit and Payment Parameters (NBPP). The letter addresses network adequacy, standardized plan options, several provisions on health equity, updating quality improvement strategy, and other topics.

Still Time to Order—Life and Health Law Manual

Make sure you have the latest requirements at your fingertips with the Academy’s Life and Health Valuation Law Manual, which contains information to help appointed actuaries and others, including:

• A current topics section outlining key valuation developments and specific state guidance;
• Current NAIC model laws and regulations that have an effect on reserve calculations;
• A discussion of generally distributed interpretations; and
• Current actuarial guidelines from the NAIC Financial Examiners Handbook.

Order today.

Academy Submits Statement to Senate Committee on Medicare’s Financial Condition

Medicare Committee Chairperson Rina Vertes and Academy Senior Health Fellow Cori Uccello submitted a statement for the record to the Senate Committee on Finance Subcommittee on Fiscal Responsibility and Economic Growth regarding its Feb. 2 hearing, “The Hospital Insurance Trust Fund and the Future of Medicare Financing.”

Committee Comments to CCIIO on Draft AV Calculator

The Individual and Small Group Markets Committee submitted comments to CMS’ Center for Consumer Information & Insurance Oversight (CCIIO) on the Draft 2023 Actuarial Value (AV) Calculator Methodology.

Health Solvency Committee Presents to NAIC

Health Solvency Subcommittee Chairperson Derek Skoog presented on recommendations from the Health Solvency Committee based on the Academy’s H2 Underwriting Risk and Managed Care Credit report to the NAIC’s Health Risk-Based Capital (E) Working Group at its virtual Spring National Meeting March 18.