Insurers seek rule change that would boost profits

Published on July 18, 2014 at 2:05 AM · No Comments

The industry wants to exclude brokers' fees from being factored into administrative costs, which would reduce consumer refunds under the health law's so-called medical loss ratio rule. Currently, the rule requires plans in the small group market to spend at least 80 percent of premiums on medical costs and no more than 20 percent on administrative costs. Other stories look at access to specialty care and predicted Obamacare disasters that never happened.

The Fiscal Times: How An Obamacare Tweak Could Save Insurers Millions
The insurance industry is quietly pushing lawmakers to tweak a very wonky rule in the Affordable Care Act that could save them money and significantly reduce the amount consumers would receive in rebates each year. At issue is the ACA's medical loss ratio (MLR) which requires insurers to spend at least 80 percent of their revenue from premiums on health care related costs and no more than 15 percent on administrative costs for large groups and 20 percent for small groups. If insurers don't meet the MLR, they are required to rebate the difference to their customers. ... Right now, the MLR includes payments to brokers and agents as part of insurers' administrative costs. Industry trade groups want that changed (Ehley, 7/17).

Kaiser Health News: Specialty Care Is A Challenge In Some ACA Plans
Primary care doctors have reported problems making referrals for patients who have purchased some of the cheaper plans from the federal insurance marketplace. Complaints about narrow networks with too few doctors have attracted the attention of federal regulators and have even prompted lawsuits. But they're also causing headaches in the day-to-day work of doctors and clinics. "The biggest problem we've run into is figuring out what specialists take a lot of these plans," said Dr. Charu Sawhney of Houston (Feibel, 7/16). 

The Milwaukee Journal Sentinel: One-Third Who Lost Badgercare Coverage Bought Plans On Federal Marketplace
About one out of three people who lost their BadgerCare Plus health insurance under the state's unusual approach to the Affordable Care Act bought subsidized health plans on the marketplace set up by the federal law, according to figures released Wednesday by the state Department of Health Services. The figures provide the first thorough look at the number of people who gained and lost coverage through BadgerCare Plus, Wisconsin's Medicaid program, under the approach taken by Gov. Scott Walker's administration. The approach expanded coverage through BadgerCare Plus for the poorest adults while dropping coverage for others who would be eligible to buy subsidized health plans on the federal marketplace (Boulton, 7/16).

CQ Healthbeat: Skepticism Voiced Over HHS' Ability to Verify Insurance Subsidies
House Republicans expressed doubt Wednesday that the Department of Health and Human Services will have a system in place to verify eligibility for insurance subsidies in time for the Nov. 15 start of open enrollment to buy 2015 coverage in health exchanges. Tens of thousands of undocumented immigrants may get taxpayer subsidies as a result, suggested Rep. Bill Cassady, R-La., at a hearing of the House Energy and Commerce Health Subcommittee. Much of the infrastructure for insurance exchange operations remains incomplete, asserted Energy and Commerce Chairman Fred Upton, R-Mich. (Reichard, 7/17).

The Associated Press: House Passes $20B Bill Cutting IRS Tax Enforcement
The GOP-controlled House passed a $20 billion measure Wednesday that would slash budgets for enforcing tax laws and new financial regulations, and a healthy food initiative that's a pet cause of first lady Michelle Obama. The House passed the bill on a nearly party-line, 228-195, vote. Companion legislation has yet to advance in the Senate and the White House has promised a veto of the House bill for numerous reasons, including a provision that would block the Internal Revenue Service from enforcing the mandate on individuals to buy health insurance under the Affordable Care Act. (Taylor, 7/16).

Vox: 7 Predicted Obamacare Disasters That Never Happened
Back in the fall of 2013, it wasn't exactly a bold move to predict Obamacare would turn out to be a complete disaster. Americans are "not interested" in signing up, talk radio host Rush Limbaugh declared on his radio show in late October. ... These days, Obamacare seems to be working reasonably well. More Americans have health insurance now than did a year ago. People who bought Obamacare say they're generally pretty happy with their health insurance plans and that they can mostly get a doctor appointment within two weeks. Looking back at expectations set last fall and this spring shows how terribly pundits and politicians expected Obamacare to go -; and how much of the predicted disaster never actually happened (Kliff, 7/15).


http://www.kaiserhealthnews.orgThis article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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