The single risk pool at risk

The Affordable Care Act’s coverage expansions in the individual and small group markets were based on a key idea—as of 2014, all who had coverage in the individual market would be part of single, state- and insurer-wide, risk pools, with separate small group single risk pools.  Indeed, the risk adjustment program would spread risk among all insurers in the individual and small group markets creating, in a sense, a single statewide risk pool in each market. The individual responsibility requirement would drive individuals into the market, while premium tax credits for moderate income individuals would pull them in.  The healthy would help cover the costs of the sick, and all would find affordable premiums.

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Connecticut: Another State to make mid-year rate reductions

On January 22nd H.R 195 was signed into law, suspending the collection of health insurance provider fees in the 2019 calendar year. The bill was originally introduced on January 3, 2017 to resolve differences throughout the year from House actions and Senate actions. From this new law, States were mandated to pass on requirements for each health insurance Issuers within their state to submit updates to rates.  

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Enhanced direct enrollment eliminates ‘double redirect’, establishes new policy management strategy

In June 2018, the Federally-Facilitated-Marketplace (FFM) is expected to launch new technology known as Enhanced Direct Enrollment (EDE) – which will allow consumers and agent/brokers to shop, enroll, and manage policy changes to Marketplace health products, without ever having to create an application on Healthcare.gov or contact Marketplace Customer Service. 

EDE is a unified enrollment experience that contains an updated, easy-to-use, portal for Marketplace members. EDE will eliminate the current “double redirect” to HealthCare.gov, using a series of CMS-based APIs to process eligibility and changes behind the scenes. This new portal will allow issuers and agent/brokers to establish and maintain relationships with members from initial enrollment, through mid-year changes, and into renewal. The goal of EDE is to provide consumers and health insurance brokers with alternatives to shop for and enroll in coverage, providing the data and tools needed to effectuate and maintain policies.  

In our new whitepaper former Executive Director for Aetna’s Exchange program and Founder, JGood Advisors, Jane Good discusses Enhanced Direct Enrollment (EDE) and this new policy strategy.

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New York SHOP program removes online enrollment & premium billing

Starting this month, NY State of Health (NYSOH) made several changes to the state’s SHOP program in an effort to give the federal tax credit to as many small businesses as possible.   

In New York, 98% of businesses have fewer than 100 employees and over 40% of the workforce is employed in these small businesses. The recent changes impacting these businesses were allowed through the November 2017 rule that allows small employers to enroll directly through issuers and brokers and still receive the small business tax credits.  

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A unified platform: Healthcare for all

On February 27th, Congressman Ben Ray Luján (D-NM), hosted a Medicaid Buy-In roundtable discussion, with the intent to connect the New Mexico Legislature with national healthcare professionals to collaborate and develop a robust Medicaid Buy-In study. The study tried to find ways to reduce the state’s uninsured rate. This would be achieved by making health insurance more affordable and allow those who earn too much to qualify for Medicaid to pay premiums for a Medicaid-like program.  

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States look to protect brokers on Healthcare.gov from commission cuts

Georgia legislation passed a bill that will create guidelines for insurance carriers to pay commission to brokers. House Bill 64 states: 

  • A carrier that issues a benefit plan in this state will pay a commission consistent with the amount proposed in the rates filed with the department 
  • No compensation is required for any individual health plan sold during a Special Enrollment Period (SEP) 

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Iowa Governor signs bill allowing non-ACA health plans

Iowa’s Republican Gov. Kimberly Reynolds signed a state law Monday that lets some insurers skirt Obamacare regulations. The law would let the Iowa Farm Bureau and Wellmark Blue Cross Blue Shield sell health plans to the farm bureau’s members that ignore the mandates. 

The mandates require insurers to cover essential health benefits such as maternity care or hospitalization and prevents insurers from charging sick people higher prices. Gov. Reynolds said the state’s market is collapsing because of the high cost of Obamacare, with many citizens choosing to go without insurance because the law is pricing them out of the market. 

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