Washington Health Policy Week in Review Archive

Washington Health Policy Week in Review is a weekly newsletter that offers selected stories from the daily newsletter CQ HealthBeat.

  • May 19, 2014 Issue
CMS Issues Final Version of Health Law Marketplace Rule

The final version of a rule outlining how health law marketplaces will operate in 2015 adopted some but not all of the suggested revisions to an earlier draft that consumer advocates recommended. Insurers also won some concessions but did not get all of the additional funding they sought to cushion potential losses in the markets.

Health Centers Seek Staff Amid Medicaid Expansion

Many community health centers are looking to add staff, particularly bilingual workers, because the expansion of Medicaid through the 2010 health law will boost demand for their services, researchers said.

Indiana GOP Governor Proposes Medicaid Expansion Using HSAs

Republican Gov. Mike Pence of Indiana recently proposed an expansion of Medicaid that would have some consumers contribute to the cost of their coverage. But Pence took out some controversial parts of an ongoing state effort, such as limiting benefits and maintaining a waiting list.

HHS Plans Outreach to Teach Newly Insured How to Use Benefits

The Department of Health and Human Services (HHS) is preparing to launch a national campaign this summer to help newly insured people understand how to use their benefits, according to a federal official who spoke at a forum on women's health at the nonpartisan Kaiser Family Foundation.

CMS Tries to Avoid More Website Pain with 'SHOP' Exchange

Federal officials plan a test launch in three to five states of a new health insurance exchange website designed for small businesses before deploying it Nov. 15 in the 36 states served by healthcare.gov.

Sale of Noncompliant Health Plans Prompts Debate over Transitional Policy

By Melissa Attias, CQ Roll Call

May 13, 2014 -- The disclosure that the Blue Cross and Blue Shield Association enrolled 3.2 million individuals in health plans as of April 1 that don't comply with the health care law's coverage requirements may give congressional Republicans more ammunition to pursue waivers and exemptions from the statute's mandates.

A Blue Cross-Blue Shield spokesman said the number, dropped at a House hearing last week, includes so-called grandfathered plans, which existed before the law (PL 111-148, PL 111-152) was enacted and have not undergone substantial changes, as well as early renewals and plans that are offered under a transitional policy recently extended by the Obama administration. That policy, announced amidst a political firestorm over cancelled plans, allowed insurers to continue to offer some plans that would have otherwise been cancelled, as long as state regulators approve.

While the law's supporters continue to celebrate higher-than-expected sign-up numbers, the 3.2 million figure demonstrates that for now the law is being implemented in a way that provides unequal levels of coverage.

It also may encourage Republican lawmakers to seek more changes to the law. Most recently, Lamar Alexander of Tennessee, the ranking member of the Senate Health, Education, Labor and Pensions Committee, asked President Barack Obama's nominee for Health and Human Services (HHS) secretary whether she would be willing to further extend the transitional policy. The administration announced a two-year extension in March, which means it applies to coverage that begins as late as Oct. 1, 2016.

Sylvia Mathews Burwell told Alexander at her May 8 confirmation hearing that she thinks it would depend on where things stand in terms of implementation.

While some experts are wary of allowing noncompliant plans to continue, others emphasize that the coverage still meets some the law's requirements and that the existence of the plans is unlikely to matter in the long run.

"What we're really looking at is the first two minutes of a football game," said Robert I. Field, a law and health management and policy professor at Drexel University. "There's a lot of play time left before we're going to know the full impact of the [health law]."

Frank Coyne, vice president in the Blue Cross and Blue Shield Association's Office of the President, provided the 3.2 million figure at a House Energy and Commerce subcommittee hearing May 7 in response to a question from Colorado Republican Cory Gardner. None of the other representatives of insurance companies present revealed how many noncompliant plans their companies have sold.

Gardner emphasized that those plans offered under the transitional policy will eventually be cancelled under current guidance. But at least one group that supports the law does not necessarily think that would be a bad thing.

Cheryl Fish-Parcham, private insurance program director at Families USA, said she thinks it's a concern that everyone is not in one set of plans that are following one set of rules. She also said that her organization believes many people will do better buying plans that meet the law's requirements, citing the availability of subsidies that could make plans more affordable and that compliant plans offer more coverage.

For example, Parcham said, plans that fall under the transitional policy could charge more money to people who are not healthy or work in a high-risk occupations, such as roofers. Those plans may also not cover a package of essential health benefits required under the law or comply with nondiscrimination or renewal provisions, she said.

"The danger is that consumers renew them without fully understanding the protections they lack," she added in an email.

But G. William Hoagland, a senior vice president at the Bipartisan Policy Center, noted that the plans covered under the transition policy still have to meet some of the law's requirements. Insurers must extend dependent coverage to young adults under age 26 and comply with the prohibition on excessive waiting periods, he said. They also have to follow requirements regarding coverage of preventive services, prohibition on lifetime limits and insurer-level rules such as rate review, he added.

"I don't think it's as serious as it might first sound," said Hoagland, who previously served as vice president of public policy for Cigna Corp. and a top Republican budget staffer. "They do have some basic requirements that they still have to meet ... These truly are transitional to give time for the carriers and the individuals to make the transition over to fully, truly ACA-compliant programs."

Hoagland also noted that a number of states chose not to participate in the transitional policy, observing that those states tended to be the ones that run their own health insurance exchanges.

In addition, he pointed to updated Congressional Budget Office and Joint Committee on Taxation estimates from April 2014 that projected that roughly 2 million people will buy noncompliant nongroup plans under the health care law in 2014. The estimates also found that, by 2016, enrollment in those plans is expected to dwindle to "negligible numbers."

With respect to the 3.2 million figure, Field of Drexel University noted that people who bought compliant plans in late March during the enrollment surge may still be included in that total because the cutoff date was April 1. That means it may be somewhat inflated.

"The fact that a lot of people are still technically enrolled in these plans may simply be a reflection of when they got new coverage," Field said.

Forgot Password

An email has been sent to {{email}} with your reset password.

Account was not found. Please go to the login page and enter a new password.

Account was not found. Please try again with a different email address.

There was an error when attempting to send to {{email}}. Please contact an administrator.