Web Marketplace Delay May Hinder Obamacare’s Goals

 

With under 90 days left until Obamacare’s government-run health exchanges are due to begin, Web insurers are “still being locked out of” offering plans on the Affordable Care Act’s exchanges. This lag could potentially “depress enrollments, and jack up insurance rates.”

At this point, no Federally-run, state-based, or partnership exchanges have “given ehealthinsurance.com and other for-profit Web markets the green light.” Experts warn that if Web-based markets are unable to partner with government exchanges, it could result in 1 million or more people failing to sign up for insurance under the law.

This delay may also signify that some of the exchanges will not be ready for business by the official October 1st target date.

How Will The Affordable Care Act (ACA) Add Up To Higher Costs?

The goals of the Affordable Care Act are to make insurance more accessible and affordable, to allow people to pay for quality instead of quantity of care, and to find sustainable funding to pay for reform provisions. However, there are 3 ways in which the ACA will add up to higher costs.

1. New Benefit Requirements: The ACA requires all health insurance policies sold to individuals and small employers to include essential health benefits, including prescription drugs and pediatric services. These added benefits come at a higher cost.

2. New Taxes and Fees: The ACA imposes new taxes and fees on the health industry, including a medical device tax, insurer tax, and exchange user fee. Some new taxes and fees will result in higher costs for the consumer.

3. New Rating Guidelines: The new guidelines lead to higher premiums for younger people who tend to be healthier. If young people cannot afford coverage and choose not to be insured, costs will go up for everyone.

 

For more info, check out this video provided by Horizon Blue Cross Blue Shield.

Brian Tarpey Honored as MDRT Royal Order Excalibur Knight

 

Brian Tarpey of the Tarpey Group at the MDRT Excalibur Knight pinning ceremony.  Pictured with him are John Nichols (a fellow Excalibur Knight), Gil Haggart (President of the MDRT Foundation), and India Ehioba (Executive Director of the MDRT Foundation).

The Excalibur Society comprises the highest level of donors to the MDRT Foundation: Excalibur Knight.  Brian Tarpey was inducted as an Excalibur Knight of the Royal Order along with John Nichols by accumulating individual lifetime contributions of USD $250,000 or more. Donors can achieve Legion of Honor or Royal Order Excalibur Knight status by donating additional deferred gifts such as life insurance and/or bequests.

The ceremony was held at the Urban Club in Philadelphia, PA at the 2013 MDRT Annual Meeting. Ironically, neither Tarpey nor Nichols knew the other was being pinned at the reception despite the fact that the two friends worked side by side at the Vancouver Annual Meeting unloading 50lb bags of rice and oats during the Million Meal Challenge.

Brian Tarpey is the youngest Royal Order Excalibur Knight in 10 years  of membership with the Million Dollar Round Table.

New Options Offered In State Insurance Exchanges

The number of insurers that offer non-group plans to consumers this fall in state-run health insurance exchanges will be much greater than the current number, according to an analysis from the Robert Wood Johnson Foundation (RWJF).

RWJF’s State Health Reform Assistance Network compared insurers offering plans prior to national health reform with insurers applying to operate in state exchanges. The analysis uses data from all 10 states that have released information on carriers that will operate in their insurance marketplaces (California, Colorado, Connecticut,District of Columbia, Maryland, Massachusetts, Oregon, Rhode Island, Vermont, and Washington).

Across the 10 states, the number of carriers offering non-group insurance plans will increase substantially, from 52 to 70 plans–an increase of 35 percent. Six of the 10 states will see more insurers operating on the non-group exchange compared to the number of significant competitors pre-reform. Four states expect no change (see table above).

“More carriers competing in a state means more choice for consumers. That increases pressure on insurers to reduce price and improve service,” said Andy Hyman, who leads health coverage programs at the Robert Wood Johnson Foundation. “This level of competition signals that the state exchanges will be vibrant marketplaces.”

Researchers focused on the non-group market because it currently offers limited options and little information to guide consumer choice, and will therefore be substantially altered by the Affordable Care Act. They say that because tax credits for individual coverage premiums require obtaining insurance through an exchange, most insurance companies committed to the non-group market will choose to participate.

Massachusetts is the only state for which the researchers have an indication of the long-term impact of reform on competition. In the seven years since the state implemented health reform, they say the number of competitors more than quadrupled and market share is now far more evenly distributed as well. The analysis says that in the year before reform (2005), Blue Cross Blue Shield of Massachusetts (BCBSM) dominated the non-group market with an 80 percent market share. In 2013 it has less than 40 percent of non-group enrollment. With re-structuring of the state’s exchange to comply with the ACA for 2014, five carriers are expected to have nearly as much, or more, non-group enrollment as BCBSM.

“How competition will develop in the states is still evolving, but early evidence is showing an increase in competition in most state-based exchanges,” saidHeather Howard, director of RWJF’s State Health Reform Assistance Network and a lecturer in public affairs at Princeton University. “The robust competition we’ll see in these states is good news for consumers, because companies have an incentive to provide high-quality, affordable plans through the state-based exchanges, and carriers are clearly interested in these new markets.”

The Children’s Therapy Center’s 20th Annual Gala

The Tarpey Group in attendance at The Children's Therapy Center gala

On June 5th, 2013, The Tarpey Group attended The Children’s Therapy Center’s annual gala. As a silver sponsor, The Tarpey Group contributed towards helping The Children’s Therapy Center in providing educational and therapeutic services for children with developmental disabilities.

The Center was incorporated as the Cerebral Palsy Center of Bergen County, New Jersey, on March 29, 1950. It was created as a Center for children with Cerebral Palsy but over the past 60 years it has grown to provide creative education and advanced therapies to children with many different types of disabilities – children who face physical, medical and developmental challenges.

The Final Regulation on Wellness Programs Has Been Released

The Obama Administration has released a final decision about changes to employer-sponsored wellness programs. Similar to the proposed rule released last winter, this rule will increase the maximum allowable reward for a health-contingent bona fide wellness program from 20% of premium value to 30%. Additionally, for wellness programs that are designed to prevent tobacco use, the maximum allowable reward value is now 50%.

The Administration has struggled with the concern that some voluntary health organizations and consumer groups have charged that health-contingent wellness programs are discriminatory. In response to this issue, the rule has created a requirement that if a person cannot physically meet health-contingent wellness program goals , the employer-sponsored plan “must provide a reasonable alternative standard that accommodates the recommendations of the individual’s personal physician.” Additionally, employers still must abide by other laws intended to prevent discrimination, such as the Americans with Disabilities Act of 1990.

The final rule will be published on June 3 in the Federal Register and will become effective 60 days later. However, it will impact group wellness programs on or after January 1, 2014.

Tarpey Group Secures $10,000 for Hurricane Sandy Relief

Brian Tarpey of the Tarpey Group presented Youth Consultation Service’s George Washington School with a $10,000 grant check, provided by the Million Dollar Round Table Foundation, to support Hurricane Sandy relief efforts. Hurricane Sandy brought unthinkable devastation to several areas of New Jersey, including the George Washington School. We hope that this grant will support the school’s efforts to restore their gymnasium, which was damaged by floods. The Tarpey Group is proud to collaborate with both YCS and MDRT.

HHS’ Billion Dollar Effort To Fund Healthcare Innovation

HHS’ announcement of its second round of healthcare innovation funding under the Affordable Care Act receives scattered coverage, including a major wire source and a national website. A handful of these sources quote statements made by HHS Secretary Kathleen Sebelius. Reuters reports that on Wednesday HHS unveiled a $1 billion effort to fund healthcare innovations that cut costs while improving health outcomes. The money will go toward awarding projects that offer new payment and delivery models for federally-run programs like Medicare, Medicaid, and the Children’s Health Insurance Program. This is the second call for such innovation initiatives funded under the Affordable Care Act. Applicants have from June 14 to August 15 to submit their models.

The Hill ”Healthwatch” reports that “the second round of Healthcare Innovation Awards will target new areas for improvement, including care for special needs populations.” HHS Secretary Kathleen Sebelius said, “I’m excited to see the innovative ideas these applicants will bring to the table. Organizations from the public and private sectors throughout the country are finding creative solutions to our healthcare system challenges and these awards will continue to stimulate these ideas.”

CBS News notes that while on a conference call with reporters, Sebelius said “the country has made strides in reducing medical costs, and national health care spending has fallen to a 50-year low. However, she said there is still more to do.” According to Sebelius, “Bringing down health care costs is our top priority.”

Modern Healthcare reports that with this round, “the CMS Innovation Center will apply a more focused approach.” This round of funding is looking for proposals in the following four categories:

  • Models that quickly lower Medicare, Medicaid, and Children’s Health Insurance Program costs in outpatient and/or post-acute settings
  • Improve care for populations with specialized needs
  • Test approaches for specific types of providers to change their financial and clinical models
  • Improve the health of populations with an emphasis on prevention

 

 

Big Insurers Demonstrate Hesitance to Sell on Exchanges

In a recent article, Reuters reports on the lack of interest shown by the nation’s largest insurers to join the Affordable Care Act’s new exchanges, which are set to begin enrolling people in October. According to the article, this means that in many states, there will be no added competition, a central tenet of Obama’s law. Recently, the four largest US insurers have signaled that they are unlikely to move beyond the areas in which they already offer coverage, meaning they will sell on less than one third of the exchanges. Still, HHS remains confident in the ability of the exchanges to encourage competition and lower prices. Spokeswoman Erin Shields Britt said, “Many people will receive up-front financial assistance to make insurance more affordable, plus many will be new or first time customers for insurance companies.”

Modern Healthcare reports on an important aspect of exchange implementation that has not been the focus of the government’s preparation for the October launch: the outreach and education of consumers who will be the marketplaces’ consumers. The article quotes Kansas Insurance Commissioner Sandy Praeger, speaking at the National Health Insurance Exchange Summit, who said, “My biggest concern is how to handle consumer calls.” Still, the article notes that Acting CMS Administrator Marilyn Tavenner recently said her agency is holding its “big outreach push for enrollment until late summer or early fall.”