Health Reform on the brink...what are timelines?

· Insurance Market Rules Effective Within Six Months of Enactment: Several insurance market rules take effect within six months of enactment, including review of health plan premiums by state departments of insurance and HHS, prohibition of lifetime benefit limits and “restricted” annual limits, a requirement that plans that cover dependents cover children through the age of 25, prohibition of waiting periods exceeding 90 days, a requirement that all individual and group plans cover preventive services without cost-sharing, prohibition of pre-existing condition exclusions for children under 19, and prohibition of coverage cancellation or rescission except in cases of fraud. Prior to the implementation of new market rules in 2014, the bill also establishes high risk pool provisions for individuals who can not obtain coverage due to health status and creates a reinsurance program for employer coverage of early retirees. Provisions related to lifetime and annual limits, dependent coverage, waiting periods, preventive services, and retiree reinsurance apply to insured and self funded plans.

· Insurance Market Rules Effective in 2011: The bill sets up a 80% medical loss ratio (MLR) for individual and small group plans and a 85% MLR for large group plans. Certain non-profit plans must meet higher MLR standards to be exempt from the annual fee on health insurers. The definition of small group follows current state law until 2014, when small group is defined as 100 employees unless a state limits the definition to 50 employees before 2017. These requirements apply to health plans inside and outside of Exchanges, including “grandfathered plans.”

· Insurance Market Rules Effective Starting in 2014: Reforms that require guarantee issue and renewal during an open enrollment period, establish risk sharing mechanisms (partly funded by insured and self funded health plans), prohibit annual limits (insured and self funded), prohibit pre-existing condition exclusions as well as premium variations based on health status, and limit premium variation to tobacco use, age (3:1 band), geography, and family composition apply to individuals and small groups to size 100 (states may limit small groups to 50 and may increase beyond 100 with expanded Exchange eligibility starting in 2017). States can pass legislation to form “Health Care Choice Compacts” to allow the purchase of individual insurance across state lines.

Now What???

Well we are not sure how many people (if any) read this blog--but for those of you who do--it basically has happened! The senate in the wee hours of this morning made the first vote to end debate on the health reform bill. There are 2 more votes and then an actual vote to approve the bill--probably on Christmas Eve.

From there the Senate and the House will form a committee to merge the 2 documents. There are still potential fireworks in this merging--mainly due to the scope of the legislation and the notable areas of difference in the 2 bills.

Regardless, we see the President signing a bill before Martin Luther King day and the State of the Union address.

What does all this mean...well time will tell. We know there won't be a public health plan. However the increased levels of government control and the option for OMP to open up the Federal employees plan (or something similar) will be interesting.
We will start evaluating and determining the impacts to our clients in the coming weeks.

On a side note--continue to watch for an extension of the ARRA subsidy related to COBRA.

Senate begins plodding through scores of amendments related to reform

The Senate has begun the cumbersome process of voting on scores of amendments already filed by the House under the Patient Protection and Affordable Care Act (H.R. 3590).

Several of these measures voted upon last week included the following:

1. Medicare Benefits Guarantee: this measure passed 100-0 and simply confirms that health reform initiatives will not reduce guaranteed Medicare benefits and that Medicare savings will be used to extend the solvency of the Medicare program;
2. Preventive Care Services Expansion: this amendment, proposed by Sen. Barbara Mikulski (D-MD), was more controversial. While it passed the Senate by a vote of 61-39, it did include a provision from Sen. David Vitter (LA) that would exclude the controversial November 2009 recommendations from the Preventive Services Task Force regarding breast cancer screening, mammography and prevention.

The Preventive Care Services Expansion would require employers to comply with these new mandates within six months of enactment of H.R. 3590 What does this mean for employers?

1.Employers would be required to offer a variety of preventive care services with no cost-sharing permitted, meaning no deductibles or coinsurance:

a. screening adults for depression;
b. intestive behavioral dietary counseling for adult patients with known risk factors for cardiovascular and diet-related chronic disease;
c. oral fluoride supplementation to preschool children older than 6 months of age;
d. screening for high blood pressure in adults aged 18 and older;
e. screening and behavioral couseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings.

Stay tuned for more information about potential amendments to be discussed and voted on by the Senate.