Affordable Care Act Update
By: Ross Weber, State Affairs Manager
Since becoming the law of the land in March 2010, the Patient
Protection and Affordable Care Act (ACA) has altered insurance
industry practices, expanded certain Medicare benefits and initiated
new payment and service delivery models. Much of the upheaval and
organizational transformation over these last three years has been
borne by the private sector as governments planned new institutions to
handle millions of newly insured citizens.
Health Insurance Exchanges Must Launch Before Oct. 1
Health insurance exchanges are a key cog in this new bureaucracy,
since they will be the mechanism through which more than 20 million
individuals and employees of small businesses purchase health insurance. While the federal government never expected states to forgo
the operation of its own exchange, 26 states rejected the local option,
while another seven chose to partner with the US Dept. of Health and
Human Services. These 33 jurisdictions represent 64 percent of the
population.
Leaders of the federal and state exchanges are frantically seeking to
certify qualified health plans, creating and testing the user experience
and educating consumers on how to buy coverage through the online
marketplace before the start of open enrollment Oct. 1. An ongoing
challenge for state and federal regulators, as well as physicians, will be
certification of network adequacy. For those states that do not currently maintain such standards for private payors, the requirements for
Medicare Advantage plans will be utilized.
Medicaid Expansion Attracts GOP-led States; Private-Public
Partnerships
As of May 24, 2013, 26 Governors announced support of Medicaid expansion according to the framework established by the Affordable Care
Act, and an additional 4 state executives will seek approval for an
alternative model to cover childless adults who earn up to 133 percent
of the federal poverty level.
The ACA provides for full federal funding of newly-eligible enrollees
for three years, beginning Jan. 1, 2014. While special legislative
sessions are being pondered in those states yet to make a decision, even
a one-year delay could mean lost federal funds totaling hundreds of
millions of dollars to cover low-income residents.
A growing number of governors v