4-26-12 Affordable Care Act Update

Federal Update


This week the House will vote on a measure that diverts funding from the Prevention and Public Health Fund to keep down the costs of student loan interest rates.  ACS CAN sent a letter to all House members opposing any legislation that would cut prevention and public health funding for any purpose, including offsetting the cost of student loan program. Read the ACS CAN press release and letter.


Medical Loss Ratio - Average Rebate Estimates for 2012


Under the Affordable Care Act, health plans must meet minimum medical loss ratios (MLR), the percentage of premium dollars that are actually spent on medical benefits rather than administrative costs and profits).  For the first time, health insurance companies are required to disclose information that is intended to help consumers understand the value they are getting for the premiums they pay. The MLR is 80 percent for the individual and small group markets and 85 percent for the large group market. The provision is in effect this year, and the first rebate checks will be issued in August based on 2011 data. Total rebates this year are estimated to be $1.3 billion. 


This week the Kaiser Family Foundation released an issue brief providing estimates of average rebates by state for those who will be affected due to the medical loss ratio and rate review provisions in the Affordable Care Act. Overall, 31 percent of those in the individual market are expected to receive rebates averaging $127.00, with enrollees in Oklahoma, South Carolina, and Texas estimated to receive the largest rebates. In the small group market, an estimated 28 percent will receive rebates, averaging $76.00.  New Jersey, South Carolina, Washington, DC are expected to have the largest rebates in the small group market. In the large group market, an estimated 19 percent will receive rebates, averaging $127.00, with Minnesota, Nebraska, and Vermont having the largest average rebates. 


ACS CAN believes the MLR provision is one of the most important short-term consumer protections the Affordable Care Act provides and it appears to be having a real impact on premiums nationwide as it prompts insurers to be more transparent and accountable. The rebates benefit those whose plans have provided too little value.  As importantly, the transparency has created new pressure on insurers to manage costs more efficiently, to the benefit of the consumer.  Insurance premiums have been rising at a considerably lower rate this year than in the past few years, and the MLR and rate review provisions in the law are undoubtedly important contributing factors to this decline.


You should know that there is widespread opposition to the MLR from the insurance brokers who believe their costs should not be included in the MLR calculation. ACS CAN opposes legislation desired by the brokers, now pending in both the House and Senate, which would exempt broker costs from the MLR.   If enacted, the legislation would likely reduce premium rebates to consumers in the future.


State Update


Division and ACS CAN State government relations directors developed a survey with their counterparts at the American Diabetes Association, American Heart Association and Multiple Sclerosis Society as part of an effort to coordinate a unified "ask" of their state insurance commissioners regarding the essential health benefits (EHB) requirements in the Affordable Care Act to which all health insurance plans operating in the exchange will have to adhere. The insurance commissioners will asked to complete the survey, which is designed to help measure the level of benefits provided to beneficiaries within the largest (by enrollment) small group plans in each state and to determine whether the plans have any "inside limits" on benefits, such as restrictions on the number of times a patient can use a particular service, e.g. lab tests or doctor visits, each year. Additional patient groups are being approached to see if they are interested in joining the effort.


Poll: Gaps in Health Coverage Faced by One-Quarter of Working-Age Americans


One of four working-age U.S. adults experienced a gap in health insurance coverage during 2011, often because they lost or changed jobs, according to a Commonwealth Fund study released late last week. Based on a national survey, the report also shows that it is difficult to regain coverage once individuals lose employer-sponsored insurance. About seven of 10 survey respondents who went through a period without health insurance lacked coverage for a year or longer. More than half were uninsured for two years or more, according to the 2011 Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults. 


Affordable Care Act Webinar

ACS CAN, the American Heart Association, the American Diabetes Association, and the National Multiple Sclerosis Society convened a webinar on Monday to review a new poll the groups commissioned highlighting voter attitudes toward the creation of health insurance exchanges under the Affordable Care Act. The research will be helpful in determining messaging that will engender public support for implementation of key provisions in the law that are improving access to quality, affordable health care for people with cancer and those at risk of developing the disease. Click here to access the recording.

FINAL.electeds.CommunicationsTips.Exchange..pdf  FinalVoters.CommunicationsTips.Exchange.pdf  presentation.Herndon exchanges for April 23rd webinar.final.pdf 

As always, thank you for all you do every day to support laws and policies that help cancer patients and their families.



Chris Hansen | President

ACS Cancer Action Network | American Cancer Society Cancer Action Network, Inc.


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