This past weekend, I attended my first NAIC meeting as a NAIC-funded consumer representative, following veteran representatives through winding hotel hallways and the maze of the Phoenix convention center. Now that the fog of the 3-hour time difference has lifted, I’m happy to report to CHIRBlog readers on the highlights of the meeting.
When the NAIC met last, it was the start of the second open enrollment. This meeting comes after nearly a dozen new commissioners joined the association, following changes in state leadership brought about by last fall’s elections and retirements, and soon after the close of the second open enrollment. But other than a report from CCIIO officials touting total enrollment in the marketplaces, state regulators barely paused to recognize the numbers or the elections and chose instead to continue the work of implementing the ACA in their states.
For those of us following the Network Adequacy Model Review Subgroup, the big news from the meeting is that the group will increase their working calls from one to two weekly calls. While this may seem like news that only concerns those who join the calls, it actually represents much more. The Subgroup, composed of state insurance regulators, was formed in early 2014 and tasked with updating a nearly two-decades-old model act. HHS initially signaled future rule making in which they would adopt tougher network adequacy standards for marketplace plans. More recently, HHS has said they’ll wait for the outcome of the NAIC effort. So this group convening more frequently to hammer out thorny questions about adequacy standards, consumer protections, and transparency requirements will bring us that much closer to action on one of the top consumer concerns since the marketplaces opened for business. Consumer representatives who urged the NAIC to take up network adequacy are hopeful that substantial progress can be made by the August meeting.
On another front, the Health Care Reform Regulatory Alternatives Working Group took up timely business as well. The working group was started in 2012 with a goal of “providing a forum for discussion of and guidance on the alternatives to implementing a state-based exchange,” among other tasks. With ACA watchers awaiting the outcome of King v. Burwell, regulators used this meeting to explore options for federally facilitated marketplaces (FFMs) to transition to state based marketplace status in the event the Supreme Court rules federal subsidies are not available to FFM enrollees. Regulators also discussed the implications of insurers meeting form filing deadlines this spring – well in advance of a King decision in late June that will provide them with critical information about who they can expect in their risk pool. Insurers might file proposed rates that assume healthier enrollees if the Court rules subsidies are available to FFM enrollees. On the other hand, if the Court rules that subsidies are not available, some experts expect only the sickest, highest cost individuals will hold onto marketplace plans if premium assistance is no longer available. One solution debated at the meeting: allow insurers to file two sets of rates, one for each scenario, as a Nebraska regulator said that state is doing. (In other discussions state regulators opined that the double filing approach is not acceptable because the non-subsidized rates are not likely to be valid and insurers would have a chance to amend their original filings if the Supreme Court rules against subsidies.)
Finally, the Health Insurance and Managed Care Committee (B committee) heard updates from representatives of CCIIO and NASCHO, an organization representing CO-OPs. After a mention of the marketplace enrollment numbers, CCIIO reported that the agency will “very soon” post the 10 plans in each state that officials will use to select an Essential Health Benefits benchmark for 2017 coverage. That will kick off a summer of EHB debate and activity, with final benchmark plans expected to be announced in late summer. After CCIIO’s presentation, regulators pushed the federal official to urge CCIIO to let states know soon what their options may be for addressing the expanded definition of small employer that will take effect in 2016. Regulators urged CCIIO to let states know soon if there are decisions to be made that will affect spring-time rate filings for small employer plans – not later, when the “eggs are already scrambled,” as one regulator said.
NASCHO representatives touted their enrollment numbers and effect on premiums and health care costs in states where they are competitive, but what regulators really wanted to hear was how the CO-OPs were dealing with financial challenges. CHIRblog readers will be familiar with the challenges most CO-OPs are facing; an analysis found all but one of the 23 CO-OPs are running at a loss based on their 3rd quarter filings in 2014. So it was no surprise to hear some regulators say they are closely monitoring cooperative plans in their states.
That wraps up the highlights of this NAIC meeting. Stay tuned for more as regulators’ work continues on the many tasks they have in implementing the ACA.