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  • Marketplace Coverage Renewals: Variation in State Approaches May Affect Consumers’ Finances - The Commonwealth Fund
    an individual s federal tax credit is pegged to the premium for the second lowest cost silver plan also called the benchmark plan For 2015 competition among plans led to a new benchmark rate in almost all markets For example every county in Kentucky will have a new benchmark plan in 2015 In Washington the benchmark plan changed in 27 of 39 counties affecting 90 percent of marketplace enrollees Colorado reported similarly dramatic changes In Oregon a different insurer is offering the benchmark plan in five of the state s seven rating areas California reported that the benchmark plan changed in 14 of its 19 rating regions If the price of the benchmark plan went down for 2015 a consumer s tax credit should decline too all else equal The estimated amount carried forward from 2014 therefore would be too high and the excess would have to be paid back on next year s tax return Conversely if the price of the benchmark plan rose the enrollee may receive a credit that is too small While such a shortfall would be corrected at tax time the reduced assistance in the interim could make premium payments unaffordable Changes in the price of benchmark plan premiums are not the only reason why enrollees tax credits may fluctuate Changes to the price of an individual s existing plan including premium adjustments as a result of enrollees growing older to household income or family circumstances and to federal poverty level guidelines used to determine who is eligible for a subsidy all mean that the tax credit calculated for last year could differ from that for 2015 How Are State Based Marketplaces Managing Renewals Exhibit 1 outlines how the federally facilitated marketplaces and the state based marketplaces handled auto renewal The California Colorado Connecticut Washington D C Kentucky Vermont and Washington marketplaces tried to improve consumers experiences by ensuring those who are auto renewed receive a more accurate premium tax credit Consumers in these states still need to report changes in income and family circumstances as they occur Enrollees who are auto renewed in other states will likely receive either too much or too little in premium tax credits because of changes to the benchmark plan and other factors Exhibit 1 State and Federal Approaches to Auto Renewal Marketplaces Allows automatic renewal of coverage Method for estimating 2015 premium tax credit for auto renewed coverage California Colorado Connecticut District of Columbia Kentucky Vermont Washington Yes Tax credit amount is updated using 2015 plan premiums and current federal poverty level guidelines Federally facilitated marketplaces Hawaii Minnesota New Mexico New York Yes Tax credit amount from 2014 is carried forward unless consumer updates account and selects plan Idaho Maryland Nevada Yes Tax credit is not available unless consumer updates account and selects plan Massachusetts Oregon Rhode Island No Tax credit is not available unless consumer updates account and selects plan Source Authors analysis of published materials and survey responses Looking Forward It was critical for the marketplaces

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2014/dec/marketplace-coverage-renewals (2016-04-30)
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  • The Extended "Fix" for Canceled Health Insurance Policies: Latest State Action - The Commonwealth Fund
    noncompliant policies after January 1 2014 For the most part these were states that are running their own health insurance marketplaces and were predictably hesitant to adopt a policy that could undermine these fledgling programs Most of these states have maintained their original position even after the administration extended the transitional policy fix by two years These states include California Connecticut Delaware Maryland Massachusetts Minnesota Nevada New York Rhode Island Vermont and Washington as well as Washington D C However at least 11 states that did not adopt the administration s original transitional policy Alaska Arizona Arkansas California Colorado Indiana Nebraska Oklahoma Oregon Virginia and West Virginia are now allowing renewals of noncompliant policies after January 1 2014 although California has limited them to the small group market renewals are still prohibited in the individual market These states will join the 29 states that adopted the administration s original transitional policy Most of these states have a federally operated marketplace and had already allowed plans to renew early prior to 2014 Yet not all states in this group have agreed to allow transitional renewals through 2017 California small group market only Colorado Oregon individual market only and New Mexico will allow the existence of noncompliant policies only through 2015 Meanwhile Arizona and Illinois will allow noncompliant policies to exist through 2016 while leaving open the option to permit these policies to continue through 2017 Why It Matters An American Academy of Actuaries issue brief points to the renewal of noncompliant policies at least in the states that adopted the transitional policy as a factor driving higher premium rates in 2015 This is because healthier people were more likely to remain enrolled in those policies making the risk pool for new ACA compliant plans sicker than insurers originally projected However the rating impact of transitional policies is just one of many factors contributing to the 2015 rates some of which will drive rates higher and some of which will push rates down While we don t yet have a clear picture of the impact of the transitional policy on premiums a recent Commonwealth Fund analysis suggests that the effect could be fairly small The continued existence of noncompliant policies may have the greatest negative impact on the small group market and the Small Business Health Options Program SHOP marketplaces in particular Early anecdotal reports suggest that a significant number of small employers chose to renew their existing coverage prior to the availability of the SHOP If this trend continues through 2017 it may not only affect premiums for compliant small group policies but also demand for SHOP coverage The transitional policy has another serious consequence At its core the Affordable Care Act is designed to remedy shortcomings in individual and small group market coverage such as preexisting condition coverage exclusions the use of health status and gender to set premiums and the lack of a minimum set of core health benefits The decision to allow noncompliant policies to continue means insurers

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2014/jun/adoption-of-the-presidents-extended-fix (2016-04-30)
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  • Implementing the Affordable Care Act: Revisiting the ACA's Essential Health Benefits Requirements - The Commonwealth Fund
    W Lucia and S Corlette Implementing the Affordable Care Act Revisiting the ACA s Essential Health Benefits Requirements The Commonwealth Fund October 2014 Add to My Library Print Toplines State variation in definition of the minimum set of required health benefits Are the ACA s essential benefits requirements protecting consumers Overview The Affordable Care Act broadens and strengthens the health insurance benefits available to consumers by requiring insurers to provide coverage of a minimum set of medical services known as essential health benefits Federal officials implemented this reform using transitional policies that left many important decisions to the states while pledging to reassess that approach in time for the 2016 coverage year This issue brief examines how states have exercised their options under the initial federal essential health benefits framework We find significant variation in how states have developed their essential health benefits packages including their approaches to benefit substitution and coverage of habilitative services Federal regulators should use insurance company data describing enrollees experiences with their coverage information called for under the law s delayed transparency requirements to determine whether states differing strategies are producing the coverage improvements promised by reform e Alerts and Newsletter Sign up Downloads Issue Brief Publication Details Publication Date October 31 2014 Authors Justin Giovannelli Kevin Lucia Sabrina Corlette Contact Justin Giovannelli Associate Research Professor Georgetown University Health Policy Institute s Center on Health Insurance Reforms Editor Deborah Lorber Citation J Giovannelli K W Lucia and S Corlette Implementing the Affordable Care Act Revisiting the ACA s Essential Health Benefits Requirements The Commonwealth Fund October 2014 Related Publications April 13 2016 Obama Administration Moves Forward with New Continuity of Care Protections How Will They Affect Existing State Laws March 30 2016 What Will Happen to Medicaid Beneficiaries If Kentucky Dis Kynects Related Topics Health

    Original URL path: http://authoring.commonwealthfund.org/publications/issue-briefs/2014/oct/revisiting-aca-essential-health-benefits-requirements (2016-04-30)
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  • The Next Frontier: Insurance Marketplaces That Promote Quality Improvement - The Commonwealth Fund
    first year of implementation these challenges were compounded by the marketplaces technological and other operational difficulties As the federally facilitated and state based marketplaces look to more widespread implementation of the ACA s quality improvement goals they would do well to keep the following in mind Consumers need more support to make quality driven plan choices Health insurance marketplaces were created at least in part to allow consumers to compare plans side by side And the ACA envisions that consumers will make comparisons based not just on premium costs and benefits but also on relative plan quality such as how well plans manage care for people with chronic conditions To date this vision has not yet been realized Consumers shopping on both the state based and federally facilitated marketplaces in 2013 and 2014 lacked the tools they needed to make plan choices based on quality data Over time however states can help consumers better understand quality data by providing web based decision support software and clear explanations of how to interpret performance data and also by training call center staff navigators assisters and brokers to answer consumers questions about plan quality States can be guided by research on how consumers use information when shopping for health insurance to structure their resources Greater standardization across the marketplaces and other purchasers can improve efficiency and drive greater adoption A health insurance marketplace is just one of many purchasers and payers operating in an environment crowded with diverse quality measure sets and initiatives Although many states shared quality information with consumers in 2014 they did not do so in a standard way While diversity allows for innovation the lack of standardization can burden providers and insurers and make comparisons more challenging Final regulations require states to display a federally developed quality rating system in 2016 while also allowing them to display their own quality metrics State health insurance marketplaces will need to weigh the value of adding state specific metrics to the federally required quality rating system particularly if they have limited resources or other operational challenges They also should consider the feasibility of aligning goals and metrics with other state purchasers such as the state employee benefits program or large private purchasing coalitions We re a long way from plan competition based on quality performance Only a few states have moved beyond quality reporting to set requirements for insurers quality improvement efforts It s possible some insurers may want to improve their performance simply because quality data are made public But until consumers are actively comparing and choosing plans based on quality or the marketplace is allowing only the highest quality plans for sale quality reporting alone is unlikely to have much of an effect Currently most marketplaces lack the infrastructure needed to conduct quality improvement activities In addition to inadequate IT systems they also lack the capacity to analyze plans quality improvement efforts and their effects on patient outcomes and costs Ultimately if marketplaces are going to be a player at

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2014/aug/next-frontier-marketplace-quality (2016-04-30)
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  • Implementing the Affordable Care Act: State Action on Quality Improvement in State-Based Marketplaces - The Commonwealth Fund
    Care Act the health insurance marketplaces can encourage improvements in health care quality by allowing consumers to compare plans based on quality and value setting common quality improvement requirements for qualified health plans and collecting quality and cost data to inform improvements This issue brief reviews actions taken by state based marketplaces to improve health care quality in three areas 1 using selective contracting to drive quality and delivery system reforms 2 informing consumers about plan quality and 3 collecting data to inform quality improvement Thirteen state based marketplaces took action to promote quality improvement and delivery system reforms through their marketplaces in 2014 Although technical and operational challenges remain marketplaces have the potential to drive systemwide changes in health care delivery e Alerts and Newsletter Sign up Downloads Issue Brief Publication Details Publication Date July 29 2014 Authors Sarah J Dash Sabrina Corlette Amy Thomas Contact Sabrina Corlette Research Professor and Project Director Georgetown University Health Policy Institute s Center on Health Insurance Reforms Editor Deborah Lorber Citation S J Dash S Corlette and A Thomas Implementing the Affordable Care Act State Action on Quality Improvement in State Based Marketplaces The Commonwealth Fund July 2014 Related Publications March 14

    Original URL path: http://authoring.commonwealthfund.org/publications/issue-briefs/2014/jul/state-action-quality-improvement-marketplaces (2016-04-30)
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  • Implementing the Affordable Care Act: State Action to Reform the Individual Health Insurance Market - The Commonwealth Fund
    Authors Justin Giovannelli Kevin Lucia Sabrina Corlette Citation J Giovannelli K W Lucia and S Corlette Implementing the Affordable Care Act State Action to Reform the Individual Health Insurance Market The Commonwealth Fund July 2014 Add to My Library Print Overview The Affordable Care Act contains numerous consumer protections designed to remedy shortcomings in the availability affordability adequacy and transparency of individual market insurance However because states remain the primary regulators of health insurance and have considerable flexibility over implementation of the law consumers are likely to experience some of the new protections differently depending on where they live This brief explores how federal reforms are shaping standards for individual insurance and examines specific areas in which states have flexibility when implementing the new protections We find that consumers nationwide will enjoy improved protections in each area targeted by the reforms Further some states already have embraced the opportunity to customize their markets by implementing consumer protections that exceed minimum federal requirements States likely will continue to adjust their market rules as policymakers gain a greater understanding of how reform is working for consumers e Alerts and Newsletter Sign up Downloads Issue Brief Publication Details Publication Date July 7 2014 Authors Justin Giovannelli Kevin Lucia Sabrina Corlette Contact Justin Giovannelli Associate Research Professor Georgetown University Health Policy Institute s Center on Health Insurance Reforms Editor Martha Hostetter Citation J Giovannelli K W Lucia and S Corlette Implementing the Affordable Care Act State Action to Reform the Individual Health Insurance Market The Commonwealth Fund July 2014 Related Publications April 13 2016 Obama Administration Moves Forward with New Continuity of Care Protections How Will They Affect Existing State Laws March 30 2016 What Will Happen to Medicaid Beneficiaries If Kentucky Dis Kynects Related Topics Health Care Coverage Mission The mission of The

    Original URL path: http://authoring.commonwealthfund.org/publications/issue-briefs/2014/jul/state-action-reform-individual-market (2016-04-30)
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  • State Restrictions on Health Reform Assisters May Violate Federal Law - The Commonwealth Fund
    services they provide Importantly the regulations also recognize that some state standards that may be permissible on their face may be unduly burdensome and therefore unlawful as applied in practice What do the rules tell us about existing state laws In the view of federal officials a number of state navigator requirements conflict with the ACA Our analysis of the new rules reveals that portions of laws and regulations in at least 15 states may impermissibly restrict consumer assisters Exhibit 2 Exhibit 2 State Restrictions on Consumer Assisters that May Conflict with the ACA Type of State Restriction Why May These Restrictions Conflict with the ACA States with Restrictions that May Be Invalid Limitations on the advice assisters may provide regarding the substantive benefits or comparative features of different health plans The new rules reiterate that assisters are required to engage in substantive discussions about the terms and features of any coverage for which a consumer might be eligible This responsibility includes clarifying the similarities and differences among particular plans and assisting consumers with making informed decisions about plan selection consistent with their expressed interests and needs State rules that prohibit assisters from providing such advice violate federal law 11 states a AZ AR GA IL LA MO OH OK TX VA WI In state residency or principal place of business requirements Assisters must maintain a physical presence in each state where they provide services and may be required to register with the state However standards that limit assister eligibility to in state residents and organizations effectively prevent national groups from serving as assisters and were specifically identified in the rules as conflicting with the ACA 3 states a IL MO WI Prohibitions on receiving compensation from an insurer even where unrelated to assistance work Federal conflict of interest standards bar assisters from receiving compensation from insurance companies in connection with their enrollment activities State requirements that go further and prohibit assisters from receiving any compensation whatsoever from insurers even if not in connection with enrollment effectively disqualify hospitals and other health care providers from serving in those capacities because they receive compensation from insurers for health care services provided These types of eligibility restrictions were specifically targeted by HHS in the new rules 5 states b AR LA MT OH WI Mandated referrals to agents or brokers for consumers who have previously purchased insurance from an agent or broker Assisters are required by federal law to provide fair and impartial help to all consumers who seek assistance State rules that require assisters to refer consumers to an agent or broker if they learn that the individual previously purchased health coverage from an agent or broker interfere with their federal obligations 2 states IL MO Requirements to purchase a surety bond or carry insurance State eligibility requirements that limit the pool of assisters in a manner that undermines the effectiveness of a marketplace s consumer assistance programs may violate federal law While HHS declined to indicate that state rules requiring

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2014/jun/state-restrictions-on-health-reform-assisters (2016-04-30)
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  • Federal Court Ruling Casts Doubt on State Power to Restrict Health Reform Navigators - The Commonwealth Fund
    pass a federal training regimen and comply with federal standards governing their conduct and operations States have flexibility to supplement these rules provided they do not interfere with navigators duties under federal law In states that ceded responsibility for operating a marketplace to the federal government it has been an open question whether regulations that place additional burdens or limitations on assisters undermine the navigator program and in turn the federal marketplace If a state requirement were found to conflict with the Affordable Care Act federal law requires that it be set aside Fresh doubts about the legality of state restrictions On January 23 2014 a federal court in Missouri became the first to weigh in on this issue in a case challenging the constitutionality of that state s navigator law Concluding that Missouri s restrictions on consumer assisters likely violate federal law the court blocked the state from enforcing the statute Missouri s navigator law is in many ways typical of other state navigator restrictions It requires navigators and other consumer assisters to meet licensing and training requirements in excess of federal obligations and to pay fees to the state The law also limits the kind of advice navigators can provide though in this respect Missouri goes further than most prohibiting assisters from giving any advice concerning the benefits terms and features of a particular health plan Last November two nonprofit groups that had satisfied federal navigator requirements sued arguing that the state s restrictions would make it harder perhaps impossible to provide the outreach and enrollment help required of them under federal law The court agreed and halted enforcement of the law Missouri s licensing requirements it said were an impermissible obstacle in the path of navigators already trained and certified by the federal government By imposing additional burdens on approved assisters before they can work in Missouri the state obstructed the operation of the federal marketplace More troubling were Missouri s limitations on navigators speech and conduct In the court s view the state s broad prohibition on advice giving directly conflicted with the responsibility navigators have to provide information about consumers coverage options and facilitate health plan selection Accordingly these provisions and all other attempts by Missouri to regulate the conduct of assisters working on behalf of the federal marketplace were invalid Looking forward The Missouri decision is an important first word on the legality of state navigator restrictions though almost certainly not the last The case itself continues the court may reverse its ruling at a later stage this seems unlikely and Missouri may appeal And as it stands the decision is not binding elsewhere similar restrictions in states like Georgia Texas and Wisconsin remain in place Nevertheless the ruling seems likely to influence by example Navigators in other states may see a greater opportunity to push back against state restrictions and initiate their own legal challenges While the result of any future lawsuit is speculative it is clear that the reasoning adopted by the

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2014/feb/federal-court-ruling-navigators (2016-04-30)
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