AHCA Impact On Payers

AHCA Impact On PayersLast week was a big week for healthcare. The American Health Care Act (AHCA) made its debut. Not many people in government and healthcare industries expect quick passage of the AHCA in its initial form, but understanding the differences with the Affordable Care Act (ACA) sets a framework for the AHCA impact on payers and providers.

Fair to say, every organization must make adjustments and the pressures for building internal organization-level efficiencies increase. BHM continues focusing on procedures and process improvements, because being lean and nimble never go out of style.

Quarles & Brady, LLP, (provider of quality legal services to a wide range of industries on a national stage) offered in their March 9thEmployee Benefits Law Update, many provisions remain. Here is an initial scorecard of the items not changing (today).

  • Coverage for children until age 26 on their parent’s plan
  • No lifetime or annual limits on essential health benefits
  • New appeal rules (e.g., external review)
  • Limits on pre-existing condition exclusions
  • No rescission of coverage
  • Limits on waiting periods
  • First-dollar coverage of preventive care benefits
  • Coverage for pre-existing conditions
  • Community rating rules
  • Limitation on rescissions
  • Loss ratio limits
  • Guaranteed availability and renewability of coverage
  • Essential health benefits,
  • Coverage for adult children up to age 26
  • Caps on out-of-pocket costs
  • No lifetime and annual limits
  • The exchanges are also not repealed by the AHCA, but they will presumably wither and die after 2020.

AHCA Impact On Payers

Employee Benefits Law Update continues with the differences:

  • Continuous Coverage Incentive to Replace the Individual Mandate. To keep the ban on pre-existing condition exclusions but prevent this market disruption, the AHCA imposes a continuous coverage incentive.
  • Age-Based Premium Tax Credits to Replace Income-Based Credits. the premium tax credits and the cost-sharing reductions, both of which are repealed by the AHCA beginning in 2020
  • Metal Levels and Age Variation in Premium Rates. The AHCA eliminates metal level requirements starting in 2020, so plans will no longer have to achieve specific actuarial value (AV) levels.
  • Health Insurer Taxes.  The ACHA repeals Obamacare’s tax on insurers beginning in 2018.
  • Patient and State Stability Fund.  The AHCA creates a “Patient and State Stability Fund” designed to stabilize the individual insurance market.

Winner- Insurance Companies: Christina Gregg, for AOL.COM, reported in a March 8th article that insurance companies where “winners” because “The bill does strike down the ACA’s individual mandate — which will likely spur a dip in enrollment — but one of the biggest differences between the ACA and AHCA is the 30 percent surcharge on policyholders who fail to keep up continuous coverage.”

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FactCheck.org and Kaiser Family Foundation (KFF) offer the bare bones review of all aspects of the AHCA bill. Kaiser Family Foundation goes the extra step by offering an interactive comparison tool for all the healthcare proposals.

Highlights from FactCheck.org:

  • Are insurance companies required to offer coverage regardless of preexisting conditions? Yes, but there’s a penalty for not having continuous coverage.
  • What happens to the expansion of Medicaid? It will be phased out.
    • Under the Republican health care plan, no new enrollment can occur under this Medicaid expansion after Dec. 31, 2019. States that have yet to opt in to the expansion by that date also will not be able to do so afterward.
    • The bill doesn’t eliminate the Medicaid expansion coverage for those who are enrolled prior to 2020. But if they have a break in coverage for more than one month after Dec. 31, 2019, they won’t be able to re-enroll (unless a state wanted to cover the cost itself).
  • Is there a requirement to have insurance or pay a tax? No.
  • Are insurers required to cover certain benefits? Yes. The bill keeps the essential health benefits requirement under the ACA.
  • Are there subsidies to help individuals buy insurance?
    • There are two forms of financial assistance under the ACA: premium tax credits (which would change under the GOP plan) and cost-sharing to lower out-of-pocket costs (which would be eliminated).
  • Will young adults under the age of 26 still be able to remain on their parents’ plans? Yes. The bill does not affect this provision of the ACA.

Highlights from KFF:

Private Insurance Standards

  • Minimum medical loss ratio standards for all health plans are not changed.
  • Requirement for all health plans to offer independent external review is not changed.
  • Requirements for all plans to report transparency data, and to provide standard, easy-to-read summary of benefits and coverage are not changed.

The new healthcare bill offers significant changes in an ever-changing healthcare landscape.  BHM clients operate in many sectors, so who better to understand the AHCA impact on payers and providers. Click HERE to learn more about how BHM can help you build success through the next phase of healthcare.

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