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Implementing Commercial Insurance Market Aspects of Federal Health Reform: A State Perspective Christopher F. Koller Health Insurance Commissioner, State.

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Presentation on theme: "Implementing Commercial Insurance Market Aspects of Federal Health Reform: A State Perspective Christopher F. Koller Health Insurance Commissioner, State."— Presentation transcript:

1 Implementing Commercial Insurance Market Aspects of Federal Health Reform: A State Perspective Christopher F. Koller Health Insurance Commissioner, State of RI April 30, 2010

2 Overview -What we are doing now -What we need to be thinking about for the future -States Challenges and Needs

3 Issues Now : High Risk Pool Grants ($5 billion – ) –For individuals who currently do not have coverage and have a pre- existing condition –Challenges: for states without high risk pool and for guarantee issue states Commercial Insurance Reforms (Plan years 6 mos. after enactment) –No lifetime limits; First-dollar coverage for preventive services –No rescissions; Appeals process –Dependent coverage up to 26 years of age –No Pre-existing Condition Exclusions for Children –MLR standards. Rate Oversight –Challenges: Reg promulgation process, communications, fit with existing statutes, implementation, other mkt impacts. Resources Grants for State Ombudsman National Web Portal

4 Key Reforms – 2014 Implementation Market Reforms: Guarantee Issue and no Pre-existing Condition Exclusions in all markets Rating Reforms limiting factors to age (3:1), geography, tobacco use and family composition 4 Coverage Tiers based on coverage categories and cost-sharing No annual limits State-Based Exchanges for Individual and Small Group markets that will provide standardized information on insurance choices and help consumers enroll in plans

5 State Action for Long Term Reforms: 1.(Stages of Grief) 2.Interagency Planning Groups 3.DC Monitoring (use of Membership Assocns) 4.Stakeholder Education and Communication 5.Exchange Planning: Goal setting Commercial and Medicaid interaction Operations 6.Eyes on the prize: Long term vision for local delivery systems (the cost issue) – payment reform, HIT, benefit design etc.

6 ME NY PA NH CT VT MA NJ VA NC SC GA FL WV KY AL MS MI WI MN IA HI AK KS NE ND SD MO IL IN TX MT ID NV UT WY CO NM AZ CA OR WA LA AR OK OH MD DE RI Community Rating 25.1:1 or greater Small Group Premium Variation DC Adjusted Community Rating Rating Band Variability: No Rating Structure19.1:1 – 25:1 13.1:1 – 19:1 13:1 or less *Note: Michigan HMOs and Blue Cross/Blue Shield are restricted to 3.12:1 maximum variation. All others may use 3.96 maximum variation TN

7 ME NY PA NH CT VT MA NJ VA NC SC GA FL WV KY TN AL MS MI WI MN IA HI AK KS NE ND SD MO IL IN TX MT ID NV UT WY CO NM AZ CA OR WA LA AR OK OH MD DE RI Rating Bands Hybrid Michigan Blue Cross/Blue Shield must use community rating. There is no rating structure for other carriers. Individual Market Rating Rules DC Adjusted Community Rating Community Rating No Rating Structure

8 State Needs and Challenges 1.Federalism made real: Coming into compliance from tremendously different starting points: technical and political issues. 2.Grandfathering of old plans (see briefing sheet). Enormous implications – good politics; bad policy. 3.New Federal Partnerships - HHS OCIIO. Competence is crucial. New roles 4.Communication and expectations with local stakeholders 5.Resources Resources Resources


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