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Universal Healthcare in Action: The ACA’s Market Reforms and Coverage Mandates

Universal Healthcare in Action: The ACA’s Market Reforms and Coverage Mandates
Product Code - LGN240
Speaker(s): Joel S. Ario, Manatt Health Solutions; Michael S. Kolber, Manatt, Phelps & Phillips, LLP
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Health reform can sometimes be thought of as a “three-legged stool.” Reforms in the individual and small group health insurance market are the first leg, allowing anyone to purchase insurance regardless of medical history or age at a reasonable premium. The requirement to purchase insurance is the second leg, taxing individuals who are not covered by health insurance. Subsidies for those to whom purchasing coverage is unaffordable is the third leg. Together, these three legs create a functioning market where healthcare coverage is affordable and of high quality to all, regardless of age, geography, employment or medical condition.

This program will detail all the market reforms and coverage mandates that are going into effect under the Affordable Care Act (ACA) to make the concept of universal coverage a reality. The faculty will cover the full range of critical changes created to extend coverage, including the abolishment of pre-existing condition exclusions and waiting periods (and where there are exceptions), the creation of single risk pools for individual and small-group markets, the adjustments in community ratings, and the availability of wellness discounts. In addition, the new provisions in place to regulate coverage terms will be explored, and the speakers will delve into the coverage of essential health benefits, including the 10 mandated benefit categories, state-by-state benchmarks, benefit design, non-discrimination issues, flexibility for insurers, and the state form review role. They will also review standardization of coverage including defining metal levels, cost-sharing reductions, and state flexibility.

Finally, coverage requirements, such as dependent coverage and minimum medical loss ratios, state options, state choices to date, and transparency requirements will be discussed. The webinar will provide a clear road map through the maze of new regulations, emerging issues and dramatic coverage changes that are re-shaping the healthcare landscape.

Attendees will learn to understand and navigate the market reforms and coverage mandates that are re-inventing the healthcare market in which they and their clients do business. They will gain critical insights into the new obligations, options, and opportunities they face, as the ACA becomes fully implemented. Every aspect of extended coverage—from new provisions for regulating terms to new requirements for standardization—will be examined in the context of what they mean in the real world. As we near the end of the first open enrollment period, this program will allow us to take a look at progress to date and what can be expected ahead.

Educational Objectives:

• Gain a thorough understanding of market reforms and coverage mandates under the ACA.

• Explore in depth the new provisions regulating coverage terms as well as options and requirements under the new rules.

• Learn to define the key aspects of standardization of coverage, including applicability, metal levels, and cost-sharing reductions for low-income enrollees.

• Examine the full range of changes extending and re-shaping coverage, from the prohibition of rescissions to minimum medical loss ratios to the expansion of dependent coverage to age 26.

• Study the impact of other ACA insurance rules (including those not yet implemented) as well as the role of pre-ACA rules such as HIPAA.

• Get a progress report on how well the ACA is going as the end of the first open enrollment period nears.

Who would benefit most from attending this program?

Those involved in health reform decisions and implementation for states, as well as general counsel, strategic planners and regulatory/government affairs executives at payer, provider, and life sciences organizations will benefit from the program. Attorneys and foundations focused on healthcare, access, and coverage issues also will get value from the program.

Program Level: Intermediate
Prerequisite: A general understanding of current healthcare issues.
CPE Delivery Method: Group Internet-Based Live
Field of Study: Specialized Knowledge and Applications
Recommended CPE Credit: 1.5 credits
Anticipated CLE Credit: 1.5 credits (may vary based on from which jurisdiction requested)

For additional information, please see the “CE Credit” tab.

Joel S. Ario, Manatt Health Solutions; Michael S. Kolber, Manatt, Phelps & Phillips, LLP

Joel S. Ario, Manatt Health Solutions
Joel Ario, a managing director at Manatt Health Solutions, has 30 years of experience helping to shape and implement public policy, including two decades devoted to leading health insurance reform efforts at the state and federal government levels. He provides strategic consulting and policy analysis to assist state governments, health plans, hospitals, foundations, and other stakeholders in preparing for the broad implications of healthcare reform, with a particular emphasis on planning for and implementing the new exchange-based marketplaces.

Mr. Ario previously served as Director of the Office of Health Insurance Exchanges at the U.S. Department of Health & Human Services (HHS), where he worked closely with states and other stakeholders in leading HHS efforts to develop the regulatory framework for exchanges, including the rights and responsibilities of the states in establishing exchanges and preserving their authority over the private insurance marketplace. Prior to his federal service, Mr. Ario was Pennsylvania Insurance Commissioner from 2007 to 2010 and Oregon Insurance Commissioner from 2000 to 2007. Mr. Ario served on the Executive Committee of the National Association of Insurance Commissioners (NAIC) for a decade and was an NAIC officer from 2003 to 2005.

Mr. Ario serves as an advisor to the Robert Wood Johnson Foundation in support of its State Health Reform Assistance Network, and is a member of the Leavitt Partners Future Panel. His publications include “Post Election, the Affordable Care Act Leaves the Intensive Care Unit for Good,” (with Larry Jacobs, Health Affairs Entry Point, Dec. 2012) and “Public Exchanges Dominate the Headlines, but Will Private Exchanges Really Shape the Future?” (Manatt Healthcare Newsletter, June 2013).

Mr. Ario earned a J.D, cum laude, from Harvard Law School, an M.Div., cum laude, from Harvard Divinity School, and a B.A. in American Political Science from Saint Olaf College, where he was a member of Phi Beta Kappa.

Michael S. Kolber, Manatt, Phelps & Phillips, LLP
Michael Kolber is an associate within the healthcare practice of Manatt, Phelps & Phillips, LLP, who focuses his practice on regulatory and transactional matters in the healthcare industry. Mr. Kolber counsels health systems, managed care plans, pharmaceutical manufacturers, technology firms, and other stakeholders on complex regulatory and compliance issues affecting their business. His practice focuses on implementation of the Affordable Care Act, especially the establishment of health insurance exchanges and the transformation of the commercial health insurance market. He also advises clients on Medicare and Medicaid managed care and employee benefits issues.

Prior to joining Manatt, Mr. Kolber was an attorney in the Centers for Medicare and Medicaid Services Division in the Office of the General Counsel of the U.S. Department of Health and Human Services (HHS). He served as the lead legal advisor to federal policymakers on central elements of health reform and provided counsel on the formation of health benefit exchanges and risk adjustment, reinsurance and risk corridor programs. He also advised HHS on defining the essential health benefits package, operating the Pre-Existing Condition Insurance Plan program, and awarding loans to Consumer Oriented and Operated Plans (CO-OPs). Mr. Kolber previously served as a law clerk for Judge Amalya L. Kearse of the U.S. Court of Appeals for the Second Circuit.

Mr. Kolber earned a J.D., magna cum laude, from Harvard Law School, where he served as Supervising Editor of the Harvard Law Review, and a B.A. with distinction from Yale University. He is admitted to practice in New York.

This program’s CLE-credit eligibility varies by state. Bloomberg BNA is an accredited provider in the states of New York*, California, Pennsylvania, Texas and Virginia, and most other jurisdictions grant CLE credit on a per-program basis. At this time, Bloomberg BNA does not apply directly to the states of Florida, Rhode Island, Montana and Hawaii although credit is usually available for attorneys who wish to apply individually. Additionally, the following states currently do not grant credit for Bloomberg BNA OnDemand programming: Arkansas, Ohio, Nebraska, and Delaware. All requests are subject to approval once the live webinar has taken place or the customer has viewed the OnDemand version. Please contact the Bloomberg BNA accreditations desk if you have specific questions that have not been addressed.

*Bloomberg BNA is an accredited provider in New York for experienced attorneys only.

Hardship Policy
For information regarding Bloomberg BNA’s Hardship Policy, please visit the Continuing Education Information page.

Individual programs, subjects, and formats may not receive credit in some states and there may be specific rules regarding who may earn credit or the maximum number of credit hours that may be earned with specific formats. For specific questions, contact your state MCLE regulatory entity for specific questions about your MCLE rules or visit the American Bar Association’s website for general information on accreditation.

If you have further questions regarding a specific state or how to file for CE credit, please contact Bloomberg BNA customer service at 800-372-1033 and ask to speak to the CLE Accreditation Coordinator or send an email to