The Senate passed legislation on Thursday intended to protect small and midsize businesses from increases in health insurance premiums, clearing the bill for President Obama’s expected signature.
The action by Congress was a rare example of bipartisan agreement on how to revise the Affordable Care Act.
An Affordable Care Act program meant to ease risks for health insurers in the law’s new marketplaces will initially pay many companies less than they expected, likely putting financial strain on some.
Federal authorities said that insurers will at first receive only about 12.6% of the money that they requested from the program, known as risk corridors, for 2014, its first year of operation. Insurers have requested approximately $2.87 billion in payments from the program based on their 2014 results. But the pool available to make those payments is just $362 million, which came from collections from other insurers that did relatively well on their marketplace business.
The goal of all insurance plans is to provide the right services to the right patient population. Insurance eligibility is a big factor, and companies spend a lot of time and effort determining if their patients qualify for coverage. The question of eligibility is also critical to the operation of the Affordable Care Act’s insurance marketplaces, and a recent OIG report found problems within the New York state marketplace that potentially led to ineligible enrollees.
Representatives from the 18 nonfederal initiatives GAO reviewed described a variety of efforts they are undertaking to achieve or facilitate electronic health record (EHR) interoperability, but most of these initiatives remain works in progress. EHR interoperability is the ability of systems to exchange electronic health information with other systems and process the information without special effort by the user, such as a health care provider. These initiatives’ efforts include creating guidance related to health data standards, encouraging the adoption of certain health data standards or policies that facilitate interoperability, and operating networks that connect EHR systems to enable interoperability.