Health Care Reform Update
Martin Mitchell, director, product policy at America’s Health Insurance Plans, provides attendees with the latest info on the Affordable Care Act.
ICAE was indeed fortunate to have Martin Mitchell, a member of the Product Policy Department at America’s Health Insurance Plans (AHIP). At AHIP, Mr. Mitchell supports state regulatory and legislative activities for health insurance products and government relations. At the ICAE Exchange, Mitchell provided an update on health care reform.
The Affordable Care Act (ACA) is sweeping in its provisions and the changes mandated for companies, regulators and consumers. To keep attendees current, Mitchell provided an in-depth overview of the ACA in terms of a historic perspective, a summary of health insurance plan regulation, a review of the legislation with timeline, and an overview of the new concepts and terminology that have become vogue since the passage of the ACA.
Perhaps most important, Mitchell reviewed what were immediate and near-term reforms, meaning those becoming manifest within the next year and those that will become manifest in the future. Mitchell noted that, as encompassing as the near-term reforms are, the long-term reforms targeted for 2014 and beyond are extremely aggressive. Some of the provisions for 2014 he highlighted include:
- Guarantee insurance for every individual and small employer applying for coverage
- Level of rating—what factors can be used in rating
- Private market reforms including:
- The elimination of preexisting conditions exclusions
- Essential health benefits package
- State exchanges
- Purchase incentives for individuals and families
- Employer responsibility to offer coverage
- Individual mandates
The future: 2017
Mitchell reviewed extensively the future-state vision of 2017. Here, the creation of standard documents for the insurance-consuming public is to be adopted at the federal level. The documents include:
- A Summary of Benefits and Coverage, and
- A Uniform Glossary of health coverage and medical terms used in insurance.
The documents, by law, will be user-friendly, geared toward an understanding level such that a majority of insurance consumers could understand the information.
Comments are currently being gathered for the standards proposed, distribution channels and a time frame for dissemination. Mitchell noted these are not off-the shelf documents, but vary by product, individual and location. The complexity of these documents, the potential importance to the insurance-buying public, and the processes needed to create them makes this a monumental task. Although Mitchell expressed support for the concepts, he noted the most pressing concerns with the standard-document mandate are the cost to produce documents and operational concerns to deploy the documents effectively.
Mitchell expresses that long-term reforms targeted for 2014 and beyond are very aggressive.
A word on enforcement
Mitchell closed with some final thoughts on the enforcement of this ruling. Of special interest to regulators, he observed that states have primary enforcement responsibilities, but federal enforcement is provided for and therefore will step in where states have failed to enforce rule against carriers.
So much information; so little time
He urged all present to keep abreast of the very complex issues involved and to work to ensure all organizations are compliant. A consummate professional, Mitchell worked on an ad hoc basis through lunch and through the Life and Health breakout session to continue the dialogue and knowledge transfer with Exchange attendees.
CONTACT INFO
Martin L. Mitchell, Jr.
Director, Product Policy
America’s Health Insurance Plans (AHIP)
601 Pennsylvania Ave., NW
Washington, DC 20004
202.861.1476
mmitchell@ahip.org
www.ahip.org
PRESENTATION
Click here to view Mitchell’s presentation
