Filed Under:Agent Broker, Personal Lines Business

The Health Care Reform Revolution–Where Are We Now?

A little more than a year ago, the 2,700-page Patient Protection and Affordable Care Act (PPACA) became law, changing many aspects of the health insurance industry and—in a domino effect—the provider market, the agent and broker community, and even state government functions. More changes are headed our way from the legislatures (both federal and state), regulatory agencies, and possibly even the judicial branch.

In the judicial arena, three courts have ruled that the individual mandate in the bill is constitutional, while three other courts have ruled it unconstitutional. In early August, a three-judge panel in the 11th U.S. Circuit Court of Appeals in Atlanta found the individual mandate unconstitutional in a lawsuit brought by Florida and 25 other states. (An interesting side note: The ruling out of Atlanta is the first case where the judges’ decisions did not track based on the party affiliation of the president who appointed them.) The U.S. Department of Justice can appeal in the 11th Circuit for a full-panel hearing versus the three-judge panel ruling recently released. The case is widely expected to end up at the Supreme Court. However, with the Court’s decision not to allow a fast-tracking of any of the related cases, it will most likely be June 2012 before the first appeals case reaches the highest court in the land.

The regulatory side has seen a flurry of activity lately with multiple regulation releases on the exchanges for both the individual market and the group market. Also being considered are three transitional programs regarding reinsurance for the individual insurance market, the establishment of a risk corridor for the individual and small group markets, and a state option to adjust risks for non-grandfathered plans. More regulations are on the way, as this will prove to be a contentious topic for most states in their legislative and budget processes.

Changes for Women
Another item recently taking center stage is the addition of specific women’s preventive care services with no cost share for plan participants. These changes will take effect Aug. 1, 2012, or the first plan renewal thereafter.

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