ACA Round-Up: Alexander-Murray And CSR Payments, QHP Quality Ratings, And More

The language of the Alexander/Murray bill is now available. Our post of yesterday, October 17 provides an on the whole accurate description and analysis of the bill. One late addition deserves further discussion, however. As noted in an earlier post, many states have already required or allowed their insurers to increase premiums to account for the shortfalls the insurers will experience for the CSR payment cut off. Rather than require the insurers to refile their rates again, delaying the 2018 open enrollment period, the proposed language would leave the increased rates in place but require insurers to rebate overpayments to their enrollees and to the federal government as appropriate. These rebates could be delivered monthly or in one-time payments; they could be paid after the year, through the ACA’s medical loss ratio rebate provisions, or in some other way. The rebates would be accounted for in determining premium tax credits and in applying the ACA’s medical loss ratio and risk adjustment program requirements. Consumers would be given notice as to how the rebates would work. The ACA’s medical loss ratio provision already provides a channel for recovering excess profits from insurers. It is problematic as an approach to clawing back excess payments by the government because the payments under current law go to consumers rather than to the government; payments are only made if insurers expenses are less than 80 percent of their premium revenue (which might not be tr...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Following the ACA Insurance and Coverage ACA section 1557 agents and brokers cost-sharing reduction payments gender identity qualified health plans Source Type: blogs