Waivers un­der fire

IT grants given as GOP es­ca­lates crit­i­cism of ACA

Modern Healthcare - - The Week In Healthcare - Re­becca Vesely

HHS is con­tin­u­ing to roll out grants and pro­grams im­ple­ment­ing the fed­eral health­care re­form law, while con­gres­sional Repub­li­cans turn up the heat on the agency’s prac­tices. Last week, House Repub­li­cans ques­tioned se­nior lead­er­ship at HHS about the num­ber of waivers the agency has granted to em­ploy­ers and health plans to de­lay cov­er­age man­dates in the law.

“I think it is an un­der­state­ment to say that these waivers have been con­tro­ver­sial,” said Rep. Cliff Stearns (R-Fla.), chair­man of the House En­ergy and Com­merce Sub­com­mit­tee on Over­sight and In­ves­ti­ga­tions. “Oba­macare was sold as all ben­e­fit—no down­side.”

To date, HHS has granted waivers to more than 900 health plans rep­re­sent­ing 2.4 mil­lion peo­ple. The waivers al­low in­sur­ers and em­ploy­ers to con­tinue of­fer­ing “mini-med” plans, which pro­vide bare-bones cov­er­age to work­ers at low cost. The waivers are one-year re­prieves from the law’s re­quire­ment that plans pro­vide at least $750,000 in an­nual es­sen­tial ben­e­fits, in­clud­ing hos­pi­tal, out­pa­tient and phar­macy cov­er­age.

“I think it’s a tacit ad­mis­sion that the Pa­tient Pro­tec­tion and Affordable Care Act is fun­da­men­tally flawed,” Rep. Fred Up­ton (R-Mich.) said at the Feb. 16 hear­ing.

But Rep. Henry Wax­man (D-Calif.), the rank­ing mem­ber, dis­agreed. He said the com- mit­tee was “us­ing its over­sight as an at­tempt at block­ing the law.” As for the waivers, he said “the process has been fair.”

Plans granted waivers rep­re­sent about 1% of the em­ployer-based cov­er­age mar­ket over­all, ac­cord­ing to HHS. Florida, New Jer­sey, Ohio and Ten­nessee are among the waiver re­cip­i­ents.

In his tes­ti­mony be­fore the sub­com­mit­tee, Steve Larsen, di­rec­tor of the CMS’ Cen­ter for Con­sumer In­for­ma­tion and In­surance Over­sight, said the waivers aim to pre­vent care dis­rup­tions.

“To be sure, lim­ited-ben­e­fit plans are not ad­e­quate cov­er­age and can leave con­sumers with un­ex­pected med­i­cal bills in the event of hos­pi­tal­iza­tion or chronic disease,” Larsen said. But he added that the waivers are needed so en­rollees don’t “ex­pe­ri­ence a sig­nif­i­cant in­crease in pre­mi­ums or de­crease in ac­cess to ben­e­fits.”

As of Feb. 1, HHS has ap­proved 90% of waiver ap­pli­ca­tions. Of those, more than 95% were granted to health plans that in­clude self­in­sured em­ployer plans, health re­im­burse­ment ar­range­ments and col­lec­tively bar­gained multi-em­ployer plans. The agency be­gan ac­cept­ing waiver ap­pli­ca­tions in Septem­ber 2010.

Larsen said HHS is an­a­lyz­ing data about mini-med plans and de­ter­min­ing what ap­proach to take for next year.

Start­ing in 2014, mini-med plans will be­come ob­so­lete and in­di­vid­u­als will be able to pur­chase cov­er­age through the health in­surance ex­changes.

HHS last week moved for­ward with the ex­changes by is­su­ing “early in­no­va­tor” grants to­tal­ing $241 mil­lion to six states and one mul­ti­state co­op­er­a­tive. The grants will al­low each to de­sign and de­ploy the in­for­ma­tion tech­nol­ogy in­fra­struc­tures to op­er­ate the ex­changes.

Kansas, Mary­land, New York, Ok­la­homa, Ore­gon, Wis­con­sin and a con­sor­tium of New Eng­land states led by the Univer­sity of Mas­sachusetts Med­i­cal School won the fund­ing. Orig­i­nally, HHS had planned to is­sue grants to only five states, but it got seven ap­pli­ca­tions and agency of­fi­cials said they liked them all.

“We re­ally do want the ex­changes to be first in class,” Joel Ario, di­rec­tor of the Of­fice of Health In­surance Ex­changes at HHS, said on a con­fer­ence call with re­porters.

The goal is for the seven early in­no­va­tors to come up with mod­els that can be repli­cated. “This will speed up the process for other states,” HHS Sec­re­tary Kath­leen Se­be­lius told re­porters. “We know that states un­der­stand their health­care needs bet­ter than any­one else.”

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