December 10, 2013
The Department of Health and Human Services (HHS) is moving ahead with proposed regulations for the Affordable Care Act (ACA) that are intended to improve operations in 2015.
There seems to be a determination to look ahead beyond the present implementation problems, and to assume that it is time to work toward a better experience a year from now.
This is an interesting and basically optimistic perspective. There seems to be an assumption that momentum is building and that existing problems will not result in major program changes—at least not for the shorter term (a few years).
Many aspects of the ACA are still “waiting in the wings” for 2015, due to delays introduced for 2014.
The large-employer mandate has been put off until 2015, as has been enrollment for the Small-Business Health Options Program (SHOP) portion of the federal Exchange www.HealthCare,gov. Similarly, the Spanish version of the marketplace has been postponed.
And there is presently confusion over the continued sale of “old” plans by insurance companies for 2014, with some states saying “yes” and some saying “no”. Efforts are underway to help compensate insurance companies for any “transitional” expenses that they incur due to such holdovers.
Against this backdrop, planned 2015 reinsurance options for insurance companies, to “promote stable individual market prices”, are being adjusted to be less burdensome.
HHS is also proposing to change the annual open enrollment period next year to begin on November 15, 2014 and extend through January 15, 2015. The objective is to give insurers more time to prepare for the following year.
When compared with 2014, this fairly short enrollment period may pressure individuals, but hopefully a year of experience will help compensate.
States are to be given more time to transition to state-based marketplaces after 2014. There seems to be a belief that, after the first year, many states may choose to move out of the federal backup (now serving 36 states) and choose to implement their own Exchanges.
Under the proposals, the maximum out-of-pocket expense for individuals is to be increased by six percent, to $6,750.
Attorneys may draw several preliminary conclusions from this effort.
Implementation of the ACA may well improve over the next year, with efforts being made to fix the technical problems of www.HealthCare.gov , and to take various other corrective program actions during 2014.
And efforts are being made to accommodate insurance companies, to reduce any resentment resulting from the struggles and conflicts of 2013-2014.
However, efforts have not yet surfaced to deal with likely complaints during 2014 about narrow provider networks that exclude certain physicians, hospitals, and organized delivery systems, or to deal with final termination of the “old”, non-conforming health plans that have been allowed to continue.
Nor have efforts yet surfaced to deal with issues that may arise as some individuals discover the large out-of-pocket maximum payments that may be experienced with some insurance policies.
Thus, ACA problem-solving efforts can generally be seen as those taking place in the short-term (going on now); longer-term problems deemed to be workable, with corrections under way; and longer-term issues with no clear path to resolution for now.
More on these and related ACA topics, with an in-depth discussion of organizational reactions to implementation issues, may be found in a recent book by the authors that describes evolution of the ACA, and in a new Practice Guide by the authors that addresses funding and access issues in health care.