The health insurance industry will be watching and waiting to see if antitrust regulators approve several big insurance mergers, whether the Affordable Care Act’s exchange market grows more sustainable, and whether states adopt new regulations governing provider network adequacy.
Looming above all those issues is the possibility of the election of a Republican president who would seek to jettison the ACA framework and replace it with an entirely different healthcare financing framework.
HealthSpan, the insurance arm of Catholic health system Mercy Health, is getting rid of its medical group and halting sales of ObamaCare policies just two years after acquiring Kaiser Permanente’s Ohio subsidiary. Spokesman Chuck Heald said HealthSpan will stop selling individual and small-group health plans on the ObamaCare exchanges to focus more on Medicare and employer plans. HealthSpan jacked up premium rates for 2016 individual and small-group plans anywhere from 9% to 32% to account for the sicker-than-expected exchange population.
Community Health Options, a not-for-profit co-op insurance company based in Maine that also sells health plans in New Hampshire, will limit individual enrollments later this month because of “higher-than-expected claims costs.”
It’s an inauspicious sign for the company, which was one of the few successful co-ops created by the Affordable Care Act. Twelve of the ACA’s 23 co-ops have folded or are in the process of closing down, all of which occurred this year.
The Centers for Medicare & Medicaid Services has proposed mandating minimum network standards for health plans sold on the federal marketplace in 2017 as part of an effort to handle the broad shift toward narrow provider networks. The Affordable Care Act requires that all medical policies on the exchanges have enough in-network hospitals and doctors for members so that “all services will be accessible without unreasonable delay.” However, the 381-page proposed rule (PDF) released Friday goes a step further, asking states to establish a quantitative measure to ensure ACA policyholders have sufficient access to healthcare providers.
The clock is ticking on new rules under the Affordable Care Act that aim to ensure that hospitals devote more resources to charity care. But an article in the New England Journal of Medicine argues that the changes, known as Section 501(r) under the Internal Revenue Code, may not be yielding the desired effect. Section 501(r) mandates that not-for-profit hospitals must provide charity care to patients who need it—by actively ensuring that those who qualify for financial assistance get it, by charging reasonable rates to uninsured patients and by avoiding extraordinary collection practices. Hospitals also must perform a community needs assessment every three years.
Consumers browsing HealthCare.gov for health insurance ahead of next week’s open-enrollment period will immediately notice a couple of items: a quicker window-shopping experience and many more high-deductible health plan options. The federal government’s exchange website launched its window-shopping feature Sunday, a week before the Affordable Care Act’s third open-enrollment period starts Nov. 1. The CMS touted the retooled site last week, although highly anticipated features such as finding in-network providers and covered prescription drugs won’t immediately be available.