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By Sara Hansard
Feb. 3 — The Obama administration is considering proposed rules and changes for the Affordable Care Act in 2015, including implementation of the delayed employer responsibility provisions, Jeanne Lambrew, President Barack Obama's deputy assistant for health policy, said Feb. 3.
“We continue our focus to prioritize what is essential while being flexible to smooth out transitions for those that need it,” Lambrew told the 14th annual National Health Policy Conference sponsored by AcademyHealth, a health services and policy research organization.
Under the ACA, employers with the equivalent of at least 50 full-time employees must provide affordable, minimum essential coverage or they must make “shared responsibility” payments of $2,000 or $3,000 per employee, if employees qualify for subsidies in the ACA online health insurance marketplaces. The requirement was delayed for a year by the administration until 2015.
The administration also will increase attention to lowering health-care costs through new delivery systems such as accountable care organizations and bundled payment demonstrations, Lambrew said.
The administration also hopes to “ratchet up” grants and for the State Innovation Models Initiative in 2014, Lambrew said. The program supports development of state-based models for payment and health-care delivery system models aimed at improving health system performance, and there will be a focus on private sector collaborations this year, she said.
“We've heard too often that providers that are trying to make advances towards more accountable, quality-based systems often are getting mixed messages from their payers, so one of our goals this coming year is to figure out how we can limit that in a collaborative way as we move forward,” Lambrew said.
Part of that effort will be an increasing focus on transparency and data to capitalize on new systems and technology to get information to health-care stakeholders, Lambrew said.
Lambrew lauded the bipartisan budget recently passed by Congress, as well as “unprecedented progress on a bipartisan and bicameral reform bill for the Medicare sustainable growth rate policy.” The administration also hopes that more states will continue health-care market and delivery system reforms, and expand Medicaid under the ACA, she said.
However, Mississippi Insurance Commissioner Mike Chaney, who spoke in a session on state coverage activities, said that the Center for Consumer Information and Insurance Oversight (CCIIO) has turned down a second attempt by the state to create its own state-based ACA health insurance marketplace.
Speaking to Bloomberg BNA after his presentation, Chaney said that the Mississippi Insurance Department was informed of CCIIO's decision by phone Jan. 3. CCIIO denied the state insurance department's request to set up its own individual marketplace because Gov. Phil Bryant (R) wouldn't approve it. CCIIO also denied the state insurance department's request to operate a state-based marketplace in 2013 because of Bryant's opposition. Mississippi is the only state that has been turned down in its request to operate a state-based individual marketplace. However, the state is operating its own Small Business Health Options Program marketplace.
Speaking on a panel on health insurance exchanges, Rogelyn McLean, an attorney in the Department of Health and Human Services Office of the General Counsel, said the HHS is considering a proposal to amend 45 C.F.R. 155-260, an ACA marketplace privacy and security regulation in effect since March 2012. The proposal would allow marketplaces, also known as exchanges, to streamline eligibility and enrollment for all federal and state health-care programs.
The proposal would open the door to allow use of information gathered from people who apply for coverage through the federal and state marketplaces to be used to qualify them for participation in other programs such as the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF), McLean said.
“What you'll see is a proposal on the books that's not only going to allow use of this information for exchange-related activities, but for other activities that a particular exchange—specifically state-based exchanges—believe will support their efficient operations,” McLean said.
Under the proposal, states would ask for approval from the HHS to use marketplace information to support the other operations if the information is secure and protected, McLean said. “There is also a provision under which the secretary, under her own power, can recognize additional uses for this information,” she said.
Richard Onizuka, chief executive officer of the Washington Health Benefit Exchange, who also spoke on the exchange panel, said many people in Washington state have probably purchased coverage through the private market after shopping on the state marketplace.
As of the week previous to the conference, 86,031 had enrolled in qualified health plans sold on the state's marketplace who have paid the first month's premium, but another 81,872 people filled out applications but have failed to pay premiums, Onizuka said. The state's marketplace website had technical problems operating in early December, and “they probably got a little worried about being able to get through by the Dec. 23rd deadline” for Jan. 1 enrollment, he said. QHP enrollment represents about 27 percent of the state's enrollment through its marketplace, he said.
Twenty-two percent of Washington's QHP enrollment is between the ages of 18 to 34, lower than the national average, while 38 percent of the enrollees are between the ages of 55 and 64, Onizuka said. He said the state is marketing to young adults, a key group needed to balance out medical costs.
Washington is one of 10 states that received a grant from the federal government for their marketplace in January. The state received a Level One establishment grant of $84 million for 2014, Onizuka said. The budget for the state's marketplace will be about $130 million in 2014.
By 2015 state marketplaces are supposed to be operated on a self-sustaining basis, and “that's the big challenge for the state-based exchanges,” Onizuka said. Washington's budget for 2015 is $40 million, he said.
Daniel Schuyler, a director at marketplace consulting company Leavitt Partners who spoke on the exchange panel, predicted that the federal and state marketplaces will enroll about 4.5 million to 5 million enrollees in 2014, less than the 7 million that was originally projected by the administration and the Congressional Budget Office.
The most significant number is those who have actually paid for their plan, Schuyler said. Anecdotally, plans report that between 60 percent to 80 percent have paid for their plans, he said. During the tax season, Leavitt Partners anticipates the numbers will go up. The number of young enrollees is beginning to rise and the numbers are likely to increase closer to March, he said.
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Information on the Health Insurance Exchange Establishment Grants are at http://www.cms.gov/CCIIO/Resources/Marketplace-Grants/index.html.
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