Monday’s release of proposed regulations on the oft-talked about health insurance exchanges sparked a feverish 244-page read by bloggers who are now exchanging their own ideas on just what the regs will mean for the health law, for employers and for people looking to buy health insurance online.
Here’s what some of them are saying:
At the Health Affairs Blog, Timothy Jost has three posts: 1) an overview of the proposed regulation, 2) how the exchanges will certify and govern health plans and 3) a look at another proposed rule released Monday on reinsurance and risk adjustment programs. Jost thinks the regulation makes it clear that the federal government “really wants the states to run the exchanges, and will go far to work with them to make this happen. HHS cannot, however, change the terms of the statute and insofar as many states object to the ACA for political reasons, continues to face a difficult task in getting them on board. There will be a federal exchange and HHS will have to tell us what it will look like.”
At The Health Care Blog, Matthew Holt talks with Michael Sandwith, a company official with ACS, a company that will be helping run insurance exchanges, on why companies like his should help run exchanges for states. His reason? “Because they’ve done it before,” Holt writes.
At ThinkProgress Health, Igor Volsky believes that health insurers are “pressuring government to transform exchanges into an automated yellow pages.” He adds: “Allowing every insurer into the new marketplaces may do wonders for the industry’s bottom line, but it can’t be the best solution for enrollees. As former Massachusetts exchange head Jon Kingsdale often observes, letting every payer in “would be like telling your grocery store they have to offer every single kind of bread baked by every single bakery.”
At the Georgetown University Center for Children and Families’ Say Ahhh! blog, Joe Touschner writes that much of the details still have to be worked out, leaving many to “squint.” “This proposal doesn’t address how families will qualify for the tax credits that will help make exchange coverage affordable, nor does it cover what the minimum benefit package will look like.”
John Goodman, at his NCPA Health Policy Blog points out an interesting use of language in the proposed regulation by quoting an e-mail from Chris Jacobs, a health policy analyst at the Republican Policy Committee: “While the Administration is trying to sell Exchanges as providing competition and flexibility, the 347 pages of regulations contain the word “require” a whopping 811 times (628 instances in the Exchange regulation, and 183 in the risk adjustment regulation). It’s worth asking: How flexible can a piece of regulation that has 811 separate references to mandates and requirements be?”
At The Foundry, The Heritage Foundation’s blog, Edmund Haislmaier says the regs are “less than meets the eye” when it comes to state flexibility: “For example, state lawmakers are particularly concerned about how Obamacare gives the exchanges control over Medicaid eligibility. Some are considering establishing an exchange mainly to retain state control over Medicaid ….”
At InsureBlog, Henry Stern does the math on what the exchanges will cost taxpayers: “Of course, it’s literally ‘your tax dollars at work,’ since ‘[t]he Congressional Budget Office predicts that by 2019, about 24 million people will have insurance through exchanges, with four-fifths of them getting federal subsidies that average $6,400 a year per person.’ [emphasis added]“
The New York Times’ You’re The Boss blogger Robb Mandelbaum looks at how employers might do the math and how regulations will affect how they might decide to cover their workers - or not. “The Affordable Care Act requires that insurance purchased on the exchange deliver certain minimum benefits, but it is silent about whether large employer plans will have to meet the same standards. … The government, [one analyst] said, will have to address this in the regulations that flesh out the law. If the requirements for exchange plans are more stringent than those for employer plans, they will probably cost more, which would make it harder for the raise an employer offers in place of coverage to meet the cost of buying coverage on the exchange.”