Posts Tagged ‘Navigators’

NAIC Commissioner’s Fall Back on Medical Loss Ratio

Wednesday, November 9th, 2011

You know that expression, “Fool me once, shame on you. Fool me twice, shame on me”? Well, it came to mind this past week at the National Association of Insurance Commissioner’s (NAIC) fall meeting in Washington, DC. Just as in March, during the NAIC’s spring meeting in Austin, the NAIC consumer representatives were lulled into a false sense of complacency. “This will be a quiet meeting,” everyone said. “No votes on health care issues.” And that Task Force that had taken up the cause of insurance agents and brokers last summer to push for removing agent compensation from the medical loss ratio (MLR)? “They’re not even meeting,” we were told. “NAIC is done with that issue,” they said.

Imagine our disappointment and surprise when rumors started to swirl Thursday afternoon—the first day of the conference—that the commissioner from Florida planned to introduce a resolution at the NAIC’s final plenary meeting, urging Congress to consider and adopt legislation to “preserve consumer access to agents and brokers.”

When we finally saw a draft, the resolution was alarming. It ignored the considerable data collected by the NAIC’s actuarial task force over the summer, as well as the thoughtful recommendations they had developed. If it passed, it could have given momentum to H.R. 1206, which renders the medical loss ratio (MLR) requirements in the Affordable Care Act (ACA) effectively useless as a tool to help consumers get greater value for their health care dollar.

Once again, the consumer representatives swung into action, alerting the media and networks of advocates in the states. Alerts went out, urging consumer groups to contact their state insurance commissioners and let them know they opposed the resolution. The good news: the advocacy worked. NAIC’s membership agreed to delay a vote on the resolution. The bad news? The issue could come back up on a call scheduled for November 22, which consumer representatives will closely monitor. However, a number of commissioners raised sufficient concerns about the lack of notice that NAIC is likely to revisit their rules for bringing up last-minute resolutions.

MLR wasn’t the only thing on the Commissioners’ minds last week. The subgroup on Exchanges, chaired by Commissioner Sandy Praeger (of Kansas), also met. They heard testimony from one of our own consumer representatives, Sarah Lueck from the Center on Budget and Policy Priorities. She did a great job outlining the importance of a seamless experience for consumers as they seek eligibility determinations and make decisions about enrolling in health plans. The subgroup appears poised to take up model regulations for Exchanges, based on the rulemaking coming out of the United States Department of Health and Human Services (HHS).

In another important development, the regulatory framework task force has begun work on a model state law to implement some of the Affordable Care Act’s 2014 insurance reforms (i.e., guaranteed issue, modified community rating, and elimination of pre-existing condition exclusions). The draft currently applies only to the group insurance market, but members discussed adding individual market reforms as well. Getting this right is really important, because this model law is likely to be the framework many states use to adopt the central reforms of the ACA. The NAIC is taking comments on the first draft, and we would encourage consumer groups to submit comments, particularly those of you from states with protections that are stronger than the minimum standards set by the ACA.

In addition, the NAIC’s health actuarial task force is taking up some challenging topics that will have direct bearing on the success of the ACA:

  • – They will be working with HHS to develop “state-specific” thresholds for reasonable health insurance rate increases. Under the rate review rule, HHS is currently using a national standard of 10 percent (if a rate increase is 10 percent or greater, it triggers an automatic review). Starting in 2012 they will transition to state-based thresholds to better reflect local market conditions.
  • – They will work on recommendations to HHS and states for the ACA’s “3 Rs”—risk adjustment, reinsurance, and risk corridors. Their most immediate task is to finalize comments on a white paper HHS released in September.
  • – They will review data on the use of self-insurance by employers, particularly smaller employers and assess whether it is increasing as a result of the ACA’s insurance reforms. This will be an important study. A number of insurance companies are becoming more aggressive in marketing self-insurance to small businesses, because it allows them to escape key insurance reforms (such as the essential health benefits package and the modified community rating).

Last but not least, I was surprised to hear a couple of broker groups take time out of their Industry Liaison meeting agenda to complain about the NAIC’s consumer representative program. They argued that the consumer reps weren’t “diverse” enough in terms of our perspective on the ACA, complained the media mistakenly report that we speak on behalf of the NAIC, and even suggested many of us have a conflict of interest because some day we might – gasp – take grants to serve as Navigators. For myself, I take their whining as a badge of honor. The fact that they would take the time to complain about our small band of consumer reps suggests that we’re actually having an impact at NAIC.

—Sabrina Corlette, Research Professor
Georgetown Health Policy Institute

Tags: , , ,
Posted in Affordable Care Act implementation, private insurance | 1 Comment »

Health Exchanges: Federal, State, or a Partnership

Monday, October 3rd, 2011

Federal or state Exchange? The question of who should run the marketplace for individuals and small businesses to shop for and buy affordable, high quality insurance has been an ongoing debate in health reform circles for a number of years. And a main decision point under the ACA is whether a state will create and run its own Exchange or have the federal government run the Exchange. To date, 12 states have passed laws to create their own Exchanges. Advocates in other states face a difficult calculation about what will be best for consumers – a federal or state Exchange – because so much is unknown about what a federal Exchange would look like. So far, HHS has provided few details.

Recent proposed regulations from HHS rejuvenated the discussion about federal Exchanges. HHS announced a “partnership model,” where states could split certain Exchange duties with the feds. With little detail in the regulations, states spent a few weeks dreaming about only working on parts of the Exchange that appealed to them, and leaving the rest for HHS to deal with. This lack of information about the partnership models made advocates, who are concerned with the seamlessness of enrollment for consumers, rightfully nervous.

Last week, the Center for Consumer Information and Insurance Oversight (CCIIO) unveiled further information on Exchange partnerships through this PowerPoint at a meeting of state officials. And the good news is that CCIIO is providing striking clarity on the Exchange: either a state creates an HHS-compliant Exchange by 2013 or the federal government will run the Exchange.

Under the federally-run Exchange, a state has a few options for partnerships. For each of these, HHS would run the enrollment and eligibility functions for the Exchange, and therefore the coordination with Medicaid.

  1. State Consumer Assistance Partnership: A state would maintain control and oversight of the Navigator program and other direct assistance to help people enroll in health insurance, including outreach and education. But HHS would oversee the website and call center for the Exchange.
  2. Plan Management Partnership: States will oversee the health insurance plans in an Exchange, including information and monitoring about the health plan options. HHS would coordinate on oversight of health plans and consumer complaints.
  3. States could choose both the Consumer Assistance and Plan Management Partnerships.

HHS was clear that, at this point, a state does not have an option to run only a Small Business Health Options (SHOP) Exchange, and have HHS run the individual Exchange, an idea explored by some states. A few things remain unclear about the federal partnership models, including how financing these Exchanges will work. More information from HHS can be found here.

We think these models could work for states, but Community Catalyst is interested to hear what you think: are the new partnership models going to be good for consumers?

– Christine Barber, Senior Policy Analyst

Tags: , , ,
Posted in Affordable Care Act implementation, private insurance | No Comments »

Navigators: Charting the Course Through the Exchange

Friday, June 17th, 2011

It seems like no matter where you turned this spring, everyone was talking about health insurance Exchanges. These competitive marketplaces for health insurance are intended to provide individuals, families and small businesses with better options and information to choose the best health plan for them. But most of us who have had to research and buy health insurance on our own know that it’s no easy task.

The majority of people who will be using the Exchange to find health insurance will be low-income and accessing subsidies. A recent study found that people in Exchanges are more likely to have low literacy rates, more limited English proficiency, and be more likely to have been uninsured in the past than the population outside of the Exchange. So, how will Exchanges ensure that people with barriers to health insurance find a path through the red tape to get the coverage and the care they need?

Consumers need a guide – and that is a “Navigator.” The Affordable Care Act included a provision for state Exchanges to fund Navigators to help people in Exchanges find the right coverage for them. There are a variety of groups that the ACA proposes as Navigators, including chambers of commerce, brokers, and community-based organizations. Our work now is making sure that states choose Navigators that are appropriate to serve the needs of the people who will get insurance through Exchanges.

As states continue to wrestle with creating Exchanges, we need to keep talking about the role of Navigators – and which groups are most likely to be trusted guides for consumers in the Exchange. Navigators should be guides who reach people in their own communities, who speak their language and understand cultural differences. Navigators should be guides who understand how difficult it can be to get and keep health insurance and who want to work one-on-one with consumers.

Community Catalyst has developed new resources to help advocates continue to talk about Navigators in your coalitions and with other stakeholders and policymakers. The Navigator role was included in the ACA to help make the Exchange marketplaces real for people. It’s our responsibility to make sure Navigators are truly representative of the people they will serve.

– Christine Barber, Senior Policy Analyst

Tags: ,
Posted in Affordable Care Act implementation | No Comments »

Insurance-palooza – the NAIC National Meeting in Seattle

Monday, August 23rd, 2010

The Summer 2010 Meeting of the National Association of Insurance Commissioners (NAIC) in Seattle Washington wrapped up last week. For those of us not lucky enough to spend a long summer weekend with a group of insurance commissioners, some friends of Community Catalyst provided the inside scoop on the meeting.

– Victory on Medical Loss Ratios. The Executive Committee of the NAIC approved the medical loss ratio recommendation made by the subcommittee on this issue. In spite of receiving a lot of pressure from insurers, brokers and other industries, the Commissioners stayed the course and remained respectful of NAIC process by voting yes on the recommendation, with very few changes.  Thanks to the consumer representatives on the NAIC, who have worked for months to ensure the MLR definition is based on actual medical costs and evidence-based quality improvement efforts. And, thanks to advocates to who called their Insurance Commissioners about this issue. This is good news – and we expect HHS to accept the NAIC’s recommendation.  What this means for advocates: This is a procedural win that is gets us closer to a tool to fight unwarranted premium increases and get consumers better value for their insurance dollars. It also demonstrates that we need to monitor these decisions and make our voices heard as necessary to ensure consumers are protected.

– Brokers feel the love. In a bizarre turn of events, the NAIC spent their summer weekend drafting an “ode to brokers.” The resolution, sponsored by a number of Insurance Commissioners, expressed support for the work that brokers do for the insurance market.  A clause in this resolution suggests that brokers should be favored as Navigators, the entities that will help to explain and enroll people in coverage and plans through the Exchange starting in 2014. This is inconsistent with the intent of the ACA, which clearly lists potential Navigators as “trade, industry, and professional associations, commercial fishing industry organizations, ranching and farming organizations, community and consumer-focused non-profit groups, chambers of commerce, unions, small business development centers, other licensed insurance agents and brokers, and other entities.” (Section 1311(i)). It is unclear what weight this NAIC resolution holds.  But one thing is certain: brokers were flexing their muscles in Seattle, and many Commissioners were impressed. What this means for advocates: We need to educate Insurance Commissioners and others in state government about the importance of community-based groups in providing public education, health plan information, and enrollment assistance, other critical roles of Navigators.

– Everyone’s thinking about Exchanges. NAIC created a tentative workplan for the subgroup charged with working on Exchanges. They are dividing into 14 smaller workgroups (leads should be posted on the NAIC website soon).  But we hear that one of the subgroups will work on a “skeleton” model law for states, which will basically track the statutory requirements and no more. Other subgroups are likely to respond to HHS’s request for recommendations on (1) network adequacy, (2) marketing standards and (3) quality measures.  Another group will tackle “principles and priorities” on a number of other big exchange topics such as governance and operations. (TBD). Another high-level liaison group will work with state Medicaid heads on plans for collaboration. What this means for advocates: The NAIC may have helpful resources as states begin to design Exchanges.  More to come.

– Lastly, though not specific to NAIC, rate review grant announcements were also made last week. A number of Insurance Commissioners talked about using the funds to increase consumer involvement in the process and get more information out to public. What this means for advocates: If your state applied for and received a grant to increase rate review, now is the time to work with your Commissioner on a plan to increase consumer involvement in the premium oversight process.

– Christine Barber, Senior Policy Analyst

Tags: , , ,
Posted in affordability, national health reform | No Comments »