Health Care Reform Resources

ACA EMPLOYER IMPLICATIONS RESOURCES

NBCH has compiled two lists of the Affordable Care Act's implications for employers.

The first resource captures financial implications for employers, namely fees and penalties that will apply. The document has been posted here for your reference.

The second resource captures all implications - financial and otherwise - that will impact employers. The document has been posted here for your reference.

Questions? Contact Colleen Bruce

2012 ELECTIONS - IMPLICATIONS FOR HEALTH CARE REFORM

The 2012 elections were closely watched because of their potential impact on health reform and Affordable Care Act implementation. With the balance of power remaining unchanged at the federal level, work that had been placed on hold will continue as we work to prepare for 2014, which is a critical year for many major ACA programs. NBCH has prepared talking points describing the impacts on budget sequestration and ACA implementation moving forward.

ALLIANCE FOR HEALTH REFORM BRIEFING WEBCAST AVAILABLE

On June 12, the Alliance for Health Reform held a briefing titled "Health Care Costs - What Can Be Done?" Though there is still disagreement about the extent to which various cost drivers contribute to the troubling trajectory of health care spending in the United States, there are success stories. This briefing took a look at some of the innovative strategies in both the public and private sectors that have bent the cost curve downwards and some that may hold promise for lowering the rate of growth of national health care spending. The briefing also featured Dr. Paul Ginsburg presenting a paper that was commissioned especially for this series. The paper examines a range of policy strategies that might promote changes in health financing and delivery that would encourage higher quality and more efficient care delivery.

Speakers:
Marilyn Tavenner, Center for Medicare and Medicaid Services
Karen Davis, The Commonwealth Fund
Scott Serota, Blue Cross Blue Shield Association
Jim Guest, Consumer Reports
David Pryor, Ascension Health
Gerry Shea, AFL-CIO
Anne Weiss, Robert Wood Johnson Foundation
Stuart Butler, Heritage Foundation

Moderator:
Susan Dentzer, Health Affairs

An archived webcast, a podcast, and supporting materials for the briefing can be found by visiting the link above.

Questions? Contact Colleen Bruce

Become a PCORI Reviewer

The Patient Centered Outcomes Research Institute (PCORI) is seeking scientists, patients, caregivers, clinicians, and other stakeholders to review funding applications for research intended to help patients and those who care for them make better-informed healthcare decisions. Reviewers are highly valued members of the PCORI community whose work is essential to helping us support research that will be scientifically rigorous and truly patient-centered. PCORI is seeking both scientific reviewers and stakeholder reviewers.

Stakeholder reviewers will include patients, caregivers, clinicians, and others with previous experience in reviewing research. In addition to patients, caregivers, and clinicians, we define stakeholders to include the following or their representatives:
Clinicians/clinician associations (physicians, nurses, pharmacists, other clinicians, professional societies and associations)
Organizational providers (hospitals, integrated delivery systems, clinics, community health centers, pharmacies, nursing facilities)
Purchasers (employers, self-insured, government, and other entities)
Payers (insurers, Medicare and Medicaid, states, and labor trusts)
Industry (drug, device, biotechnology, and technology vendors)
Policymakers (elected officials or policymaking entities)
Educational institutions

According to PCORI's authorizing statute, approximately one-half of its operating budget will come from a per-covered-life fee on plan sponsors. Therefore, employers have an important role to play in making sure the employer/payer persepctive is represented in grant decisions.

If you are interested in applying to be a reviewer, contact Colleen Bruce. More information can be found on the PCORI website: http://www.pcori.org/get-involved/call-for-reviewers/

STATE HEALTH INSURANCE EXCHANGES

On Monday, March 12, HHS released the final rule for health insurance exchanges, which includes specifics about state functions and responsibilities. The final rule outlined the minimum standards states must meet in establishing and operating their exchanges, such as individual and employer eligibility for enrollment. The rule also outlines minimum standards that health insurers must meet to participate in an exchange and the standards employers must meet to participate in the exchange. The regulation aims to offer states "substantial discretion" in both the design and operation of their exchanges, according to the rule.

HHS fact sheet: view here

Final rule: view here

The final rule incorporated provisions of two separate but related proposed regulations issued last year, on July 15 and Aug. 17. It included more flexibility than the earlier draft rules for states to determine eligibility for their exchange; provided greater detail on the role of agents and brokers in the exchange; and specified more privacy protections for enrollee data. The rule also codified a “conditional approval” status for states that have made significant progress in creating an exchange but are expected to miss the January 2014 start date. The regulation's goal of offering states “substantial discretion” in both the design and operation of their exchanges drew praise from insurers. Read more here. (Modern Healthcare requires a freesubscription)

Insurers and other industry representatives will get to fill as many as half the seats on the governing boards for state health insurance exchanges, while at least one seat must be reserved for a consumer representative. The long-awaited rules are likely to disappoint consumer advocates who would have preferred the governing boards be dominated by consumers. But they may also frustrate insurers who had sought to prevent the governing boards from imposing requirements on plans beyond what is included in the 2010 health care law. HHS left that possibility in place, however, writing, “We continue to believe that states are best equipped to adapt the minimum exchange functions to their local markets and the unique needs of their residents.” Read more here.

Many observers are concerned cost sharing could be undermined if small employers with relatively healthy insured populations stay out of the Small Business Health Options Program (SHOP) in the health insurance exchanges. Firms with sicker employees would face increasing premiums because there wouldn't be enough healthy workers to balance the risk, HealthLeaders Media reports. According to the National Federation of Independent Businesses' Kevin Kuhlman, there so many unknowns in the ACA, including essential benefits, that small businesses are likely to try to stay away, using grandfathered health plans or self-insurance instead. Read more here.

While it’s clear that the health insurance exchange regulation will have a big impact on insurers and consumers, less obvious is that it’s a big deal to hospitals as well. In large part, that’s because of the requirements that health plans must meet for contracting with providers. Read more here.

Brokers and other third-party administrators will be allowed to direct people to state insurance exchanges and check to see if they are qualified for tax credits under long-awaited final regulations released on Monday. That means a possible new business model for insurance brokers or any other companies looking to set up an access point to the state insurance exchanges — something that concerns some consumer groups. Read more here.

*If you haven’t done so already, and you are especially interested in following state health insurance exchange implementation, consider signing up for the bi-weekly newsletter on state health insurance exchange implementation from Health2Resources (H2R). H2R is a highly respected consulting firm/think tank in the DC area that is following and reporting on this important provision of the ACA. Sign up here.