Obamacare Health Insurance Regulations and Exchanges Could Be Here to Stay

Efforts to legislatively dismantle the reforms and requirements of the Affordable Care Act may nevertheless leave behind significant remnants of Obamacare provisions, such as limits on exclusions for pre-existing conditions as well as the health insurance exchanges.
The Politico has an article suggesting that, even if Republicans find a way to repeal the Patient Protection and Affordable Care Act, many of the insurance rules and regulations issued as a result of the Obamacare legislation could be here to stay.[1]

Obamacare is more focused on the health insurance industry than the health care industry.
Although Obamacare is styled as a health care law and described as reform for the health care industry, the legislation is actually more narrowly focused on health insurance law and reform of the health insurance industry. As discussed in a previous Insurance Regulatory Law article, the health insurance industry has already begun to shift as a result of legislative reforms like Obamacare.

The Politico suggests that, even if a new administration takes a "legislative wrecking ball" to the Affordable Care Act, what remains after the dust clears could nevertheless "cause some pretty serious policy headaches."[2]

From the Politico:
GOP Hill aides are still working through the details of what they can rip out of the Affordable Care Act through budget reconciliation — the same complex process used more than two years ago to usher through final passage of the health law.

There’s broad agreement Republicans could use the legislative maneuver to go after the law’s individual mandate — and it doesn’t matter whether it’s a tax or a penalty; either is fair game under reconciliation.

Health policy analysts are split on what else can stay under reconciliation and what can go. There’s uncertainty, in particular, on what would happen to the new insurance rules — such as requiring insurers to cover people with pre-existing conditions. The Senate parliamentarian — Congress’s rule maker — will be at the center of any decision.

Keith Hennessey, a research fellow at Stanford University’s Hoover Institution, agreed that much of the law could be unspooled under reconciliation but predicted that some discretionary programs could remain intact.[3]
The Politico questions whether Congress would seek the repeal of Obamacare's health insurance market reforms "including a requirement for insurers to offer coverage to anyone who seeks it and a ban on charging customers based on their medical histories."[4]
Insurers have warned that allowing those market reforms to stay without mandating that virtually everyone have insurance would encourage people to wait until they’re sick to seek coverage, driving up the cost of insurance.[5]
Another important consideration is the health insurance exchanges that the individual states are required to develop under Obamacare. The exchanges have been described as health insurance markets where individuals and small businesses can shop online for competitively priced health insurance coverage. Each state must have its own exchange up and running by January 1, 2014, or else the federal government will step in and set up an exchange for the state.[6]

Health insurers likely to press forward with health insurance exchange development.
IT industry experts see the recent Supreme Court decision upholding the individual mandate as a sign that health insurers will abandon their "wait-and-see phase" and press forward with health insurance exchange development. In order to be ready to participate in the new online marketplaces, health insurers will have to integrate "their back-end electronic enrollment, fulfillment, billing and reconciliation systems" with the exchanges.[7]

The clock is ticking, according to those experts, in part because open enrollment for the health insurance exchanges will have to begin in late 2013 to be ready for the January 1, 2014 deadline.[8]

Some argue that Affordable Care Act subsidies are not available to those who buy insurance through federally-run exchanges.
The Affordable Care Act also includes certain subsidies to help consumers pay for health insurance bought through the exchanges. But the issue of whether those subsidies are available only to consumers who purchase insurance through a state-run exchange, or if they are available to all consumers including those that purchase through a federal exchange, is already turning into a brawl according to the New York Times.[9]

The law states that “each state shall” establish an exchange and that subsidies will be provided to residents of a state with respect to health plans offered “through an exchange established by the state.”[10]

Some say that means that only people who purchase coverage through an exchange set up and run by a state are eligible for the subsidies. Others say that Congress clearly intended the subsidies to be available for those who purchase through federal as well as state exchanges.[11]

According to the New York Times, the federal government could be running the exchanges in one-third, or even one-half, of the states because "local officials have been moving slowly or openly resisting" the exchanges.[12]
The dispute has huge practical implications. The Congressional Budget Office predicts that 23 million uninsured people will gain coverage through exchanges and that all but five million of them will qualify for subsidies, averaging more than $6,000 a year per person. Subsidies, in the form of tax credits, will be available to people with incomes from the poverty level up to four times that amount ($23,050 to $92,200 for a family of four).[13]
The one thing that is clear with respect to the future of the Affordable Care Act is that it will likely continue to produce just as much legislative, political, administrative and industry turmoil (and expense) despite the Supreme Court's decision on the individual mandate.

1 comment:

  1. It seems that this health care program in the United States may have been affected by. Although it's aim is to bring good quality but affordable patient care, they also have some negative effects on some aspects. Insurance companies like prudential life sees to it that negative effects won't occur, and that the proper health care is still provided.

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