Insurance Market Reform

Beginning in 2014, the Affordable Care Act (ACA) introduces major reforms, including the start of a new advance payment Premium Tax Credit designed to lower the cost of coverage for qualified families purchasing in the new Health Insurance Marketplaces (exchanges).  While employer-provided coverage receives significant tax preferences, tax credits for individual or non-group health insurance have not been used in a broad way. What’s more, the advanceable and refundable nature of these new tax credits introduce new elements that most consumers have not previously encountered. Taken together, these facts raise the possibility that consumer confusion might be a barrier to using this new program to enroll in affordable coverage. 

Policy experts predict that small employers, especially those with younger and healthier employees, will increasingly establish “self-funded” health plans, leaving the traditional fully-insured market to obtain lower premiums and avoid market reforms under the Affordable Care Act. Through interviews with stakeholders in 10 study states, this paper describes factors that may influence whether and how extensively this change will occur. It also shows that states have minimal data on this potentially growing market, but they would be well served to improve their monitoring efforts so they can identify any increases in small group self-funding and resulting adverse selection, and respond appropriately.

Stemming from training at insurance departments in various State Network states, Georgetown University Health Policy Institute (Georgetown) has released updated form review checklists. These resources are designed to help insurance regulators effectively implement Affordable Care Act (ACA) provisions, regulations, and other guidance by ensuring that insurance forms submitted by carriers meet all the ACA requirements.  They are in writable Microsoft Word document form, allowing insurance regulators to simply download and modify to their state’s specifications.

This proposed rule released by the IRS provides further detail on the minimum value that employer-sponsored coverage must provide in order to comply with the ACA and not be subject to the employer mandate penalty. It also provides additional guidance on premium tax credits.

 This bill modified Maryland state law to conform with consumer protection and insurance market reform provisions in the Affordable Care Act.