business

Panel warns against possible ACA loopholes

Commissioners will have consumer recommendations in hand when they draft model health insurance legislation and regulations.

By — Posted Aug. 28, 2012

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

The Affordable Care Act takes some major steps to rein in insurance company abuses, but a panel of consumer advisers to the National Assn. of Insurance Commissioners says it will be up to government regulators to make sure health plans don’t discover and exploit loopholes in the new rules.

The group of 20 consumer representatives to the NAIC released a report Aug. 13 with dozens of detailed recommendations to state insurance regulators and the U.S. Dept. of Health and Human Services that the authors want to see followed as states implement the ACA (link).

The authors work for organizations such as the American Heart Assn., American Cancer Society and Consumers Union as well as state-specific advocacy groups. However, the report does not represent the policy of those groups specifically.

The report is limited to the insurance reforms in the ACA, so it does not address the other elements in the reform law, such as Medicaid expansion or health care delivery models.

Many of the recommendations identify ways insurers could circumvent the spirit, if not the letter, of the law and suggest ways to block that from happening. For example, the report said insurers could intentionally delay responding to applications for coverage from people with chronic illnesses. Doing so could prompt them to choose other insurers, meaning insurers that are slow to respond avoid paying for costly medical care associated with the applicants’ illnesses. For that reason, the group recommends setting a time limit by which a company has to respond to an application for coverage.

There have been no accusations or indications that insurance companies have done anything specified in the report.

The report was distributed to NAIC members as well as staff at the U.S. Center for Consumer Information and Insurance Oversight, said Sabrina Corlette, a consumer representative and research professor at the Center on Health Insurance Reforms at Georgetown University in Washington.

She said NAIC members are drafting model legislation for states implementing the ACA, so the consumer recommendations hopefully will help them understand the implications state rules could have on people buying and depending on health insurance beginning in 2014.

“We try to come at these issues with a consumer lens — what it means for patients and for families trying to navigate this crazy health system we have,” Corlette said.

Health insurance trade group America’s Health Insurance Plans is reviewing the report and has no comment, said spokeswoman Clare Krusing.

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn