Monday, September 17, 2012

Employers complain to Obama Administration that ACA requirements are still unclear

Nervous because you still aren’t certain about how the Patient Protection and Affordable Care Act’s (ACA’s) rules will impact your company’s bottom line? You’re not alone. At a hearing on September 12 to discuss implementation of the ACA’s health insurance exchanges and related provisions, Congressman Sam Johnson (R-TX) complained in an opening statement that the Obama Administration has relied too heavily on interim final rules for implementing ACA mandates on pre-existing conditions, dependent coverage, and grandfathered health plan policies. The problem with this, explained Johnson, is that the regulations then take effect before employers or health care providers group can submit comments on any particular regulation’s effects.

Johnson also complained that the Administration has issued guidance in an informal format such as bulletins and FAQs. Guidance in those formats can change at a moment's notice, he noted. According to Kaiser Health News senior correspondent Mary Agnes Carey, who attended the hearing, (, panelists declared that "We really need those regulations because they really have more of the force of law, and we need them now."

November 16, 2012 is the deadline for states to notify the Department of Health and Human Services (HHS) regarding their intent to operate a state health exchange, and enrollment in exchanges is to begin in approximately one year from now, but there are nearly 100 areas where exchange-related regulations are still forthcoming, Johnson said, adding, “How are states supposed to commit tens of millions of dollars towards exchange implementation in the face of such uncertainty? How can states be expected to make decisions without so much as a final regulation to inform their decisions?”

With regulations on the mandated benefit package and expected out-of-pocket costs in plans offered via the exchanges still lacking, and without knowing what the mandated benefit package will look like, employers, said Johnson, have no way of knowing if they will be subject to the rather substantial employer mandate tax, making it difficult to make investment decisions regarding new employees, equipment or facilities. Johnson also highlighted tasks insurance plans will have to complete, including the design, price and marketing of plans, education of agents and brokers, and the establishment of provider networks.

Employers are understandably nervous, but Carey reported that the administration’s explanation for not having the actual rules in place was that it wanted to take all the stakeholder input it had received into account when drafting the regulations. Carey added that the administration pointed out that “…states have until November to say whether or not they actually want to run an exchange. So once they know how many states are involved, then they can decide when the federal government has to step in and in what states. And also, they’re talking about more regulations coming out in early 2013.”

Carey also said that “…one statement that was made was, ‘Look, if we get to the spring of 2013 and these regulations aren’t out, then we’ve got something to worry about. But with enrollment starting in the fall 2013 and the exchanges up and running in 2014, we’ll still have plenty of time to give you the certainty you want.’"


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