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December 2010

Proposed HHS Rule Calls For Health Rate-Hike Scrutiny

From: Property-Casualty.com


WASHINGTON—A proposed federal regulation will require health insurers to publicly disclose that they are seeking rate increases of 10 percent or more in the individual and small group markets.

The regulation, unveiled today by the federal Department of Health and Human Services, deals with a core market served by health insurance agents.

Under the proposed regulation, such increases are not presumed to be unreasonable, but will be analyzed to determine whether they are unreasonable.

Happy Birthday Wishes to the Data Quality Act

December 21, 2010 marks the tenth anniversary of the Data Quality Act (DQA), also known as the Information Quality Act, 44 U.S.C § 3516, note.

The DQA has deep roots developed over nearly a half-century as the result of a seed planted during the Johnson Administration which germinated in the Nixon Administration, was watered by the Carter Administration and whose product was harvested by the Reagan Administration, made available to the public in the Bush I Administration and subsequently enhanced by the Clinton Administration and promoted by the Bush II and Obama Administrations. See: http://thecre.com/ombpapers/SystemsAnalysisGroup.htm and http://thecre.com/quality/20010924_fedinfotriangle.html

Examining Judge Hudson’s Decision On The Individual Mandate

From: Health Care Blog

by Timothy Jost

On December 12, 2010, Judge Henry Hudson of the Eastern District of Virginia became the first federal judge to hold a provision of the Affordable Care Act unconstitutional. 

The lawsuit was filed by the Attorney General of the Commonwealth of Virginia immediately after the reform statute was signed into law in March.  It challenges the constitutionality of the minimum essential coverage requirement, known informally as the “individual mandate.”  This provision requires all uninsured individuals lawfully present in the United States and not incarcerated to purchase a basic, high cost-sharing, health insurance policy or pay a penalty, as long as their income exceeds the tax filing limit, they can afford a health insurance policy for 8 percent of their income or less, they do not have a religious objection to being insured and they do not belong to a health care sharing ministry.

HHS spells out final medical-loss ratio rules

From: American Medical News

Washington — The Health and Human Services Dept. issued final regulations on Nov. 22 on what health insurers must do to meet medical-loss ratio requirements as part of the new health system reform law.

Starting in January 2011, if health plans don’t spend enough of their premium dollars on medical care and quality improvement, they must provide a rebate to customers in 2012.

Insurers will need to report publicly how they spend premium dollars beginning next year, according to the new rules. The regulations also specify that insurance companies in the individual and small-group markets need to spend at least 80% of the premium dollars they collect on medical care and quality improvement activities; those in the large-group market must spend at least 85%.

Rate Review: Spotlight on State Efforts to Make Health Insurance More Affordable

The Patient Protection and Affordable Care Act creates a new federal role to examine “unreasonable increases” in the premiums charged for certain individual and small group health plans.  Under the health reform law, the U.S. Department of Health and Human Services (HHS) will work with state insurance departments to conduct an annual review of unreasonable rate increases, and insurers must provide justification for such increases to HHS and to the public via their websites.  The new law also allots $250 million for state insurance departments to enhance their process for reviewing proposed rate increases.
This study examines the existing laws and regulations in all 50 states that currently govern the review process for health insurance rates.  It finds dramatic variations across states, with some states having with no authority at all and others with robust authority to review and approve or disapprove rates before they are implemented.  Researchers also interviewed insurance regulators in 10 states (Alaska, Connecticut, Colorado, Idaho, Louisiana, Maine, Ohio, Pennsylvania, South Carolina, and Wisconsin) to see how different levels of rate regulation work in practice.  

The study was conducted by researchers at the Georgetown University Health Policy Institute and the Kaiser Family Foundation.
Reports,  Studies  and Toplines Icon Report (.pdf)

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