Essential Health Benefits: A coalition of patient groups has asked HHS to extend the comment period beyond the end of this month on current efforts seeking to establish a defined set of essential health benefits.  The administration’s decision last month to leave these determinations largely to the states has resulted in calls for a delay in implementing a key regulation of the Affordable Care Act.

Meanwhile, the American Center for Law and Justice and Susan Seven-Sky, plaintiffs in other suits challenging the constitutionality of the individual mandate on religious grounds, submitted a brief to the Court last Wednesday, asking to join the 26 states and the NFIB in their case against PPACA. The Court has not yet responded to their request.

In other news concerning the case, last Friday was the first deadline for the submission of amicus, or friends of the court, briefs. Twenty-two groups that either agree with the federal government on the constitutionality of the individual mandate or with the NFIB and the states on the point that since the law does not contain a severability clause then the entire law must be stricken if certain portions are declared unconstitutional, submitted supporting briefs to the Court. Additional deadlines are forthcoming for the submission of amicus briefs on other key points and positions, so many more briefs will be filed between now and the start of oral arguments in March. 

The House Ways and Means Committee, on Wednesday, January 18, will mark up H.R. 1173, which would repeal the CLASS Act under PPACA. HHS last fall announced that it would not proceed with implementation of the CLASS Act.

The House Republican retreat will be held Thursday, January 19 and Friday, January 20.

House Democrats will hold their retreat a week later on Thursday, January 26 and Friday, January 27.

Conferees appointed to the committee to negotiate an extension of the payroll tax holiday UI, SGR will meet for the first time on Tuesday, January 24.

The State of the Union is scheduled for Tuesday, January 24.

The CBO Budget Outlook is scheduled to be released on Tuesday, January 31, and media reports indicate that the President’s budget proposal is expected to be released on Monday, February 6.
]]> http://bewellinsurance.wordpress.com/2012/01/19/this-week-in-washington/feed/ 0 bewellinsurance http://bewellinsurance.wordpress.com/2012/01/11/your-support-is-needed/ http://bewellinsurance.wordpress.com/2012/01/11/your-support-is-needed/#comments Wed, 11 Jan 2012 01:15:28 +0000 www.bewellinsurance.com http://bewellinsurance.wordpress.com/?p=523 ]]> As many of you are aware, Be Well Insurance Solutions has made it a priority to keep you, our clients, prospects and friends, informed regarding the Patient Protection and Affordability Care Act (PPACA), also known as Healthcare Reform or the Affordable Care Act (ACA).

Recently, the Department of Health and Human Services (HHS) made the decision to dismiss the National Association of Insurance Commissioners (NAIC) recommendation to include Insurance Agents/Brokers in the Medical Loss Ratio (MLR).

So what does this mean and how will it affect you? 

MLR is included in the PPACA framework, which means that 80-85% of every dollar must be spent directly on your healthcare. The other 15-20% is left for the carriers to spend on their administrative costs.The NAIC was specifically charged by Congress to craft the MLR guidelines for PPACA and present their recommendations to the HHS. On November 11, 2011, the NAIC recommended that Health Insurance producers, agents/brokers, be included in the 20% portion of the MLR.

On December 2, 2011, HHS issued a final rule and an interim rule addressing a variety of issues relative to the PPACA medical loss ratio (MLR) requirements. Unfortunately, HHS did nothing to mitigate the adverse effects the MLR rule is currently having on the ability of insurance producers to serve the demands and needs of the health care consumers.

According to the current definition, health insurance brokers’ commissions are considered an administrative cost and must make up no more than 15-20% of healthcare premiums. This has many industry analysts worried that brokers’ revenues will dry up as this will leave little for carriers to spend on administrative functions and force health insurance brokers out of business; which in turn means less protection for Americans needing health care coverage.

Health Insurance Brokers offer their clients valuable services that are currently built into the cost of their premiums. If brokers are no longer compensated by the carriers, the cost of the services we currently offer our clients will have to be passed on directly to our clients through consulting and added fees, which many small to midsize business owners cannot afford. Especially in these challenging economic times!

For this reason, the National Association of Health Underwriters and Be Well Insurance Solutions ask you to urge your Congress members to Support HR1206.

You can help protect your health and financial wellbeing by clicking here to support of HR1206:   http://bit.ly/vTn0po

In addition, we are also asking you to personally mail a letter on your company letterhead explaining what health insurance agents and brokers do for you. SAMPLE Letter- We need our broker–KLG edits-so

Attached is a sample letter, but feel free to write a letter in your own words. Completed letters can be emailed to SOliverez@BeWellInsruance.com or faxed to (408) 615-1280.

To learn more about MLR requirements, please visit: http://bit.ly/wB2R0R

Please make sure all letters are delivered on or Before January 19th, 2012, to the below email or Fax, and I will deliver them personally when I am visiting with your Congressmen and Senators.

If you should need any further clarification regarding this Call To Action!  Please do not hesitate to email or call Sylvia Oliverez at:  SOliverez@BeWellInsurance.com or (408) 667-2602.

Thank you in advance for your time and support!

Professionally licensed health insurance agents, brokers and consultants provide valuable services to individuals and employers to obtain prices for coverage that best fits their needs. Licensed specialists design benefit plans, explain coordination issues of public and private benefits to individuals/employees, and solve problems that may occur once coverage is in place. They are also at the forefront of helping to design and implement cutting-edge health promotion and wellness programs for employers—a focus that everyone agrees is key to combating increasing health care costs.

Some contend that agents and brokers add unnecessary expense to the cost of health insurance and that a government-run entity can substitute for the role and value of professional benefit specialists. However, the record clearly indicates that government bureaucrats are ill-equipped to provide the personal service, timely objective information, guidance and accountability that professionally trained and licensed agents and brokers deliver on a daily basis.
Visit:

http://bit.ly/fOhXbi

To share your views with Congress.

Urge Your House Member to Cosponsor HR1206

December 18, 2011: The Obama administration avoided a potentially brutal lobbying battle over the medical benefits insurers must cover under the U.S. health-care overhaul when it decided last week to hand the decision off to states.

The Dec. 16 ruling, coming less than a year before the presidential elections, gives states the power to set coverage levels for the policies uninsured people will buy through regulated marketplaces, called exchanges, starting in 2014. Business groups will argue for a narrow set of benefits to save costs while consumer advocates push for more coverage. The decision shifts the debate to statehouses and away from the White House, and lets President Barack Obama say he’s giving governors and legislatures more flexibility within their own communities to confront rising medical costs and control changes brought about by the 2010 health-care law.

“Obama has taken all the grief he can stand over health care,” said Erik Gordon, a business professor at the University of Michigan in Ann Arbor, in an e-mail “He doesn’t want it to give the Republicans any more political ammunition. He is passing the hot potato to the states.” About 24 million people are projected to buy coverage through exchanges by 2019, according to the Congressional Budget Office. Premiums will average $5,800 for individuals and $15,200 for families in 2016.

Similar Services

Under the new guidelines, state lawmakers must either set coverage levels in line with widely subscribed small- business plans in their communities, or peg them to benefits included in their state employees’ health plan, federal employee plans or the largest commercial managed- care plan in the state.

Generally, health plans for small businesses, state employees and federal workers “cover similar services,” including doctors’ visits, hospitalization and outpatient mental health, according to a study conducted by the U.S. Health and Human Services Department ahead of the Dec. 16 announcement.

Differences arise in areas such as prescription drugs. While they’re covered as a basic benefit by all government employee plans, only 84 percent of small business plans include them. The others require additional premiums, the study found. Small business plans also don’t tend to cover dental care, acupuncture, bariatric surgery and hearing aids, unless states require it, the study showed. Federal plans cover those services.

Business’ Preference

“Businesses would rather deal with states, many of whom are far more sympathetic than Washington is to claims that high benefits will bankrupt employers,” the University of Michigan’s Gordon said. “Given the competition for jobs, I expect to see regulatory arbitrage bid down required coverages,” he said. The lack of national standards may allow some states to skimp in areas such as maternity coverage, said Debra Ness, president of the National Partnership for Women & Families in Washington, in a statement.

The administration’s ruling is “a grave disappointment” that ignores the health-care law’s direction “to develop a detailed package that would apply uniformly to plans across the nation,” Ness said. States that have delayed implementing the health-care law have one less excuse for not moving forward, said Ethan Rome, executive director of Health Care for America Now, a coalition of labor and civil rights groups that supports the statute.

Balancing Priorities

“This shifts the battle over essential benefits to state capitals, where the insurance lobby is strongest and where it will advocate for inadequate benefits that won’t meet the needs of people,” Rome said. “State regulators need to have a transparent process in making these important decisions and should stand up for consumers.”

Neil Trautwein, a vice president at the National Retail Federation, heads a coalition of business groups and insurers lobbying for a narrow coverage package. He says both the federal and state governments need “to develop a rule that balances state-selected and reasonably comprehensive benefits with affordability for employers and Individuals,” no matter which state is involved. Rules that do otherwise “will make health coverage more expensive for employers and individuals to purchase and make jobs more difficult for employers to create,” he said.

Guaranteed Coverage

Many states already set minimum benefit levels in regulating insurers. Idaho, for instance, mandates insurers to cover just 13 types of health services while Rhode Island requires coverage of 69, according to the Council on Affordable Health Insurance, an industry group. The health law, though, created insurance exchanges as a way to guarantee coverage for those who don’t have it now and for people who find it hard to be accepted by a health plan because of pre-existing medical conditions.

The federally mandated exchanges are central to the law’s goal to expand coverage to as much as 95 percent of Americans. The law, though, left open many questions involving how thye would be set up and run, opening the way for the Obama administration to control that through regulatory guidelines.

The decision not to impose national standards is in line with other moves by the administration this year as it develops rules to expand coverage to a projected 32 million people.

More State Options

Regulations released by the U.S. Deparment of Health and Human Services in July gave states wide latitude to design and run the markets. The administration also offered conditional certification for states that make good-faith efforts to establish exchanges but aren’t able to meet a 2013 deadline.

HHS also issued several directives it said were aimed at giving states more options to design their own Medicaid programs. States and the federal government run Medicaid, with the U.S. approving changes in eligibility standards by granting waivers from national law. The program is among the biggest expenses for states and also a prominent vehicle to expand coverage to the uninsured under the law.

A February letter from the U.S. to states raised the prospect of dropping some adults with incomes exceeding 133 percent of the federal poverty level from the program to close budget shortages.

Still, foes of the 2010 health-care law say the moves don’t go far enough.
The law itself is the issue, not how it is regulated, said Senator Orrin Hatch of Utah, the senior Republican on the Finance Committee, suggesting that it will remain a key campaign issue in the presidential elections no matter what the Obama administration does to dim protests on specific issues.

“The framework proposed by the administration takes away the right of individuals to chose the health care plan that best fits their needs,” Hatch said after the administration announced states would set benefit rules.

December 12, 2011:The Republican members of the House Energy and Commerce Committee have sent a formal letter of inquiry to the past leaders of the National Association of Insurance Commissioners (NAIC) in order to establish if the Department of Health and Human Services may have inappropriately influenced the NAIC’s actions on its initial medical loss ratio (MLR) recommendations last year. The inquiry appears to be focused on whether or not HHS pushed state regulators into a set of policy recommendations that could hurt health insurance agents and brokers.

The NAIC’s initial recommendations to HHS on the MLR that were sent last October urged HHS to accommodate producer compensation in any federal MLR rule that was promulgated, but the NAIC’s specific recommendations did not provide for a carve out of agent/broker commissions. There was an effort amongst a group of 15 bipartisan insurance commissioners leaders last year to exclude independent broker compensation from the definition the NAIC developed of earned premium for MLR reporting purposes, but at the last minute the sponsors of that recommendation pulled it back and never brought it to a vote.

This past November, the NAIC voted as a body to endorse a resolution encouraging both HHS and Congress to take expedient action to amend the MLR provisions of the PPACA in order to preserve consumer access to agents and brokers. However, HHS did not heed this recommendation in its final MLR rule promulgated on December 1. Instead, the rule continues to treat independent producer compensation as a health insurance carrier administrative expense for MLR reporting purposes.

HHS’s interim and final regulations on the MLR are nearly identical to the model regulation crafted by the NAIC last year, and Republicans seem to suspect that HHS might have led the NAIC down a very specific path in drafting those recommendations. NAHU will keep our membership updated about whatever the outcome of this congressional probe on the MLR may be.

We (www.NAHU.org)  continue to have meetings with key Senators about a companion bill to H.R. 1206, and timing is important.  NAHU is working to get the House bill to the floor and passed as quickly as possible.  It is important for you to know – and to relay to your Senator – that the supporters of H.R. 1206 represent a wide range of perspectives.  Everyone from original sponsors of the health reform measure passed in the House to members of the Tea Party leadership have signed onto this bill.  There are 18 Democrats on the measure and 122 Republicans.

As you know, NAHU has also continued to work with the National Association of Insurance Commissioners (NAIC) to ensure their support in amending the MLR provisions to accommodate agents and brokers.  . These efforts resulted in the NAIC’s recent adoption of a resolution urging Congress to act legislatively and for HHS to act via regulation.  Despite the pleas of the NAIC, the HHS MLR Regulation released last Friday, December 2, did not include improvements for brokers and their clients..  That is why NAHU has always advocated for a legislative solution, as it is the only way to guarantee a comprehensive and permanent fix.

Now is the time to send a strong message to your U. S. Senators about the devastating impact that the MLR calculation requirement is having — not just on health insurance agents and brokers and their employees, but also on your clients—the millions of employers and individual Americans who purchase private health insurance coverage each year..

By asking our Senators to step forward and support health insurance agents and brokers, along with their employees and their clients, we keep this issue center-stage.  The Senators have so many other competing issues before them that we need to maintain a constant presence in varying forms to keep this issue elevated.

Please “Take Action” now before Congress adjourns for the holidays.  Send a message urging your Senator to cosponsor a companion bill to HR 1206 in the Senate, and to push the bill to the top of the heap and get it passed!.

http://capwiz.com/nahu/issues/alert/?alertid=57927501&queueid=7668320586

Thank you for continuing to make your voices heard as a part of NAHU advocacy!!

To share your views.