How would you assess the first year of the Affordable Care Act’s Performance?

by | Aug 1, 2014 | Affordable Care Act, Patient Protection and Affordable Care Act | 0 comments

With several technological issues of the Health Insurance Marketplace (exchange) rollout, frustration mounted as visitors to the website for Maine and New Hampshire and the Vermont Health Connect website for Vermont were hampered from enrolling in health coverage. Eventually, most of the technological glitches were addressed and nearly eight million Americans enrolled in coverage through the exchanges. In all three states, Northeast Delta Dental offered Stand Alone Dental Benefit (SADB) Plans. More than 4,500 people enrolled in these plans and now have access to dental coverage through Northeast Delta Dental for 2014.

Let’s review our journey to date and then explore likely outcomes related to the procurement of medical and dental coverage. Open enrollment for 2014 was scheduled to begin October 15, 2013. Vermont, running its own exchange, was on schedule. The federal exchanges in Maine and New Hampshire were delayed by a month. However, when the exchanges were made available to individuals (SHOP exchanges were scheduled to be functional in the fall of 2015), there were many challenges. Vermont Health Connect had several technical glitches, and the federal exchanges for Maine and New Hampshire were not able to handle the volume of users and crashed. Even individuals that were able to enroll online were not confident that they successfully obtained health coverage.

Once the exchanges became functional, more than 40,000 individuals in Maine and New Hampshire and more than 38,000 in Vermont enrolled. Of these a vast majority received some form of subsidy through the exchanges.

Among those satisfied with their non-Affordable Care Act (ACA) compliant medical plans, there was a scramble to renew their existing plans known as ‘grandmothered plans’ in order to avoid a change in health coverage. The government recognized the need for action and sanctioned the ‘grandmother plans’ through a ‘transitional relief’ program for certain medical plans. This enabled the plans to remain ‘as is,’ many until 2016. This did not affect SADB Plans at all.

Now, confidence is high that an individual can utilize the exchanges to obtain coverage. Although some technological issues persist, such as mid-term changes in family enrollment, the new ‘normal’ is that enrollment can be confirmed in a timely manner, and the necessary information and payment will be properly transferred from the exchange to the carrier. Northeast Delta Dental has collaborated with the exchange operators to address any “blips” and we do not anticipate significant future challenges.

Anthem was the only medical carrier participating on the exchange in New Hampshire in 2014. At least four new carriers, Harvard Pilgrim, Maine Community Health Options (Maine based co-op), Assurant Health, and Minuteman Health (Massachusetts based co-op) have applied to the New Hampshire Insurance Department (NHID) for consideration to include their plans on the exchange for the 2015 enrollment period. They are waiting for approval from the NHID and Health and Human Services. Northeast Delta Dental offered the only SADB Plan for the 2014 rollout; however, other dental insurance carriers have applied and are waiting for 2015 approval.

Small Business Health Options Program (SHOP) exchange implementation is expected to be functional this fall for 2015 plans for employers with fewer than 50 full-time equivalent employees in Maine and New Hampshire. However, employees will not be able to take advantage of full ‘employee choice’ (a choice of multiple plans at the same metal level) until at least the 2016 plans. For 2015, small group employers in Vermont will continue to directly enroll with carriers for ACA “exchange certified” small group plans offered through Vermont Health Connect.

The government is now working on an automatic renewal and reenrollment plan for 2015. The proposed rule was posted on July 1, and public comments were accepted until July 28. After reviewing feedback, the government will publish a final rule and guidance. In the interim, testing of the auto-renewal technology requirements continues.

A recent ruling by a Washington, DC court cast doubt on whether or not federal exchanges can offer subsidies for health coverage. The administration is going to appeal that decision. Meanwhile, the decision has been stayed, which means at the moment the subsidies for many people in New Hampshire and Maine will stay in place.
Vermont is a state run exchange and would not be affected by the ruling because subsidies for state run exchanges are specifically mandated by the ACA.

In summary, as long as Congress and the administration resist compromise and fail to identify solutions to the unintended consequences of the ACA, barriers to a smooth, successful implementation will continue to exist, inhibiting the ACA from fully achieving its original goals of:

    • Improving the affordability of health insurance
    • Significantly decreasing the number or people who don’t have health insurance
    • Reducing the cost of health care in the United States

Northeast Delta Dental will continue to update you on the many challenges and associated solutions of the ACA.

Tom Raffio
August 2014

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