Insurance Market Reform

This most federal guidance clarifies that individuals have until March 31, 2013 to enroll in coverage through the health insurance marketplaces to avoid being subject to the penalty for not maintaining minimal essential coverage.

This new Alliance for Health Reform Toolkit, produced with the support of the Robert Wood Johnson Foundation, details the ACA's employer requirements and penalty. It also provides information about the delay in the employer mandate to 2015, and analysis about its impact on employer-based coverage. The Toolkit includes: key facts about the employer mandate; data about trends in employment-based health coverage; links to news articles and reports explaining and analyzing the issue; and health care experts who understand the issue and its implications, along with contact info.

The Multi-State Plan Program, established under the Affordable Care Act , directs OPM to contract with private health insurers in each State to offer high-quality, affordable health insurance options called Multi-State Plans (MSPs). MSPs are being administered in 30 states and the District of Columbia. This map details the MSP options that are available in the participating states.  

On August 30, 2013, the IRS published final regulations implementing the shared responsibility provisions of the ACA. The regulations address, among other matters, the complex question of when Medicaid eligibility amounts to minimum essential coverage (MEC) for purposes of the Act’s tax penalties. Because people with MEC are barred from receiving premium and cost sharing assistance for Marketplace plans, the final rules also have important implications in the area of health policy for children and adults with disabilities, who may need both basic insurance and supplemental Medicaid coverage for their more extensive health care needs. Many of Medicaid’s most important disability-related eligibility categories are optional with states and, therefore, monitoring whether and how agency policy on when Medicaid counts as MEC will be an important issue to watch over time.

This analysis of rate review activities in calendar year 2012 shows that the rate review process saved consumers approximately $1.2 billion on their premiums when compared to the amount initially requested by insurers. In the individual market, the average rate request increase dropped by 12 percent after rate review, saving consumers an estimated $311 million. In addition to the $1.2 billion saved due to rate review, consumers received an additional $500 million in medical loss ratio rebates for 2012, for a total $1.7 billion in savings in 2012. Moreover, insurers were much less likely to submit requests for rate increases of 10 percent or more in 2012 than in previous years, and it is likely that this change in issuer behavior is a result of the Affordable Care Act policy that requires requests for increases of 10 percent or more to be justified and reviewed.