Health Care Reform Supreme Court Edition

Transcription

1 Health Care Reform Supreme Court Edition Lisa Hawker - EVP & Employee Benefits Practice Leader Joel Wood Joel Kopperud Scott A. Sinder Kate Jensen

2 Supreme Court Decision - Affordable Care Act is Upheld Chief Justice Roberts IM = Tax for Constitution IM is NOT a Tax for Anti-Injunction Act IM Violates Commerce Clause Medicaid Expand or Die Violates 10 th Amendment Concurrence (Breyer, Ginsburg, Sotomayor, Kagan) IM & Medicaid Expand or Die = OK Dissent (Kennedy, Scalia, Thomas, Alito) IM is NOT a Tax for Constitution IM Violates Commerce Clause Medicaid Expand or Die Violates 10 th Amendment All of PPACA Should Go ( Universal Coverage Policy Goal)

3 Politics What Happens Now? Ds Wanted Law As-Is Rs Wanted Repeal and Replace Decision: Medicaid Doughnut Hole Pre-November? Post-November? Obama White House & Split Congress? Romney White House & Split Congress? Republican Sweep?

4 Reforms Already in Place - STAY Grandfathering Coverage up to Age 26 Annual/Lifetime Limits (phase-in begun) Pre-Ex for Children Free Preventive Care (non-gf only) MLR (insured only) Rebates start 2012

5 Reforms Already in Place (Cont d) STAY Premium Increase Reviews (insured only) Started 2011; HHS doing review in some states Waiver of Annual Limit Rule for Mini-Meds (exp. 2013) Claims Review (non-gf only) Federal external review in some states Delayed eff. for 24-hour urgent review Uniform Coverage Summary Disclosures (all plans) Final rule & templates issued; effective for open enrollment period or plan year beginning Sept. 23, 2012

6 Open Rule-Makings MOVING FORWARD Definition of Essential Benefits (all plans: lifetime/annual limits; package in small group market) State benchmarks; timing? Auto Enrollment (all > 200 employees) Effective after rules issued; DoL delayed rule-making (2014? 2015?) Non-Discrimination in Favor of Highly Compensated Employees (non-gf plans)

7 Open Rule-Makings (Cont d) MOVING FORWARD Notices to Employees Regarding Exchanges; Reporting to IRS Regarding Coverage (all; 2013/2014 ) Wellness Programs (30% reward; grant program) Quality of Care Requirements; Reporting

8 2014 Package KEEP PLANNING Individual & Employer Mandates Exchanges Subsidies & Premium Tax Credits Essential Health Benefits Package & 60% Minimum Value Community Rating (non-gf sml grp mkt) Guaranteed Issue/Guaranteed Renewal

9 2014 Package (Cont d) KEEP PLANNING Cadillac tax (all; 2018) W-2 reporting rules only Reinsurance & Risk Adjustment Program Participation (insurers) Risk Corridor Program (exchange plans only; )

10 Employer Mandate Still Many Unanswered Questions No Final Rules (begins 1/1/14) Requests for Input: Employer Size; FT Status Calculating Plan Affordability (9.5%, 60%, safe harbor) Information Flow to/from Exchanges Calculating Penalties

11 Exchanges Timeline 1/1/13 State/ Regional Exchange Certification Mid-2013 Exchanges must be operational for Open Enrollment 1/1/14 Open to Individuals and Small Employers 1/1/17 May Open to Large Employers Late 2010 Mid 2013 Exchange Development 11/16/12 Exchange Blueprints Due 1/1/15 Exchanges Financially Self-Sufficient

12 State Exchange Implementation

13 HHS Final Rule on Exchanges & QHPs Agents & Brokers Private website enrollment (ind. mkt - for now) QHP enrollment; subsidy applications Navigator-eligible (subject to conflict of interest rules and no issuer compensation for QHP enrollment) Agent/broker info posted on exchange websites May sit on exchange boards + regular stakeholder consultation req d SHOP Exchanges Many Questions Still Unanswered HHS focus on ind. mkt in final rule Per HHS, expect 2012 SHOP-specific rules/guidance State Exchange Blueprints Due Nov. 16, states waited too long?

14 Federally-Facilitated Exchanges & State-Fed Partnerships Federally-Facilitated Exchanges (State Opt-out) QHP certification (open market model for at least 1 st year) Accreditation and quality reporting (phased-in approach) Eligibility determinations and enrollment (partner w/ state Medicaid and CHIP agencies) Consumer support, outreach and education (incl. Navigators Program; robust role for agents/brokers) SHOP Exchanges State definition of small employer (i.e., 50 or 100 employees) 2014 & 2015 State-Federal Partnership Exchanges (State Opt-in) Potential State Roles: Medicaid, CHIP, and Reinsurance 2 Types of Partnerships: 1. Plan Management Partnership (state does QHP certification, management, and reporting); and/or 2. Customer Assistance Partnership (state does in-person assistance, incl. Navigator Program and agent/broker rules)

15 Health Care Reform Supreme Court Edition Lisa Hawker - EVP & Employee Benefits Practice Leader Joel Wood Joel Kopperud Scott A. Sinder Kate Jensen