2016 ACA Update: Good News/Bad News? PDF
Preview 2016 ACA Update: Good News/Bad News?
2016 PLUS Medical PL Symposium 2016 ACA Update: Good News/Bad News? Chicago– April 20 & 21, 2016 2016 ACA UPDATE: GOOD NEWS/BAD NEWS? MODERATOR: Susan Angelo, SVP, Managed Care Division Leader, OneBeacon Healthcare Group PANELISTS: Susan Huntington, Esq., Counsel, Day Pitney Jim Jacobson, Esq., Senior Vice President and General Counsel, Medica Kenneth White, J.D., Managed Care Practice Leader, Willis Towers Watson What We Will Cover • CO-OPs & Exchanges – Reasons for their formation – Funding & structure – Why have they failed? – What are the consequences? – Lessons learned • ACA Update & Risk and Exposure – Update on progress and status of ACA – Review emerging risks and exposures resulting from ACA CO-OPs Susan Huntington Health Lawyer Day Pitney, LLP How do you like the PLUS Medical PL Symposium so far? Text to: 22333 Amazing: 330432 Incredibly Amazing: 330433 It’s Alright: 330439 Standard text rates apply ($0.20 est.) We have no access to your phone number What is a CO-OP? Consumer Oriented and Operated Plan (CO-OP): A new type of non-profit health insurer created by the Affordable Care Act. CO- OPs are directed by their customers and are designed to offer individuals and small businesses more affordable, consumer- friendly and high quality health insurance options. CO-OPs may operate locally, state-wide, or in multiple states and must be licensed as issuers in each state in which they operate. CO-OPs will be able to offer health plans both through the health insurance exchanges and outside the exchanges. Source: www.healthinsurance.gov CO-OP Goals • Privatize insurance • Increase competition • Affordable product offerings through not-for-profit companies CO-OP Goals (cont.) • Reinvest all profits to improve pricing and/or benefits for members • Establish governance by a majority vote of members, with ethics and conflict-of-interest standards that guard against insurance industry involvement • Operate with a “strong consumer focus” Current Status • 23 CO-OPs created, receiving $2.4 billion in low-interest federal loans • Funding from premiums with an implicit guarantee of federal tax dollars to cover any losses (risk corridor payments) • 13 are either insolvent or in receivership; 1-2 more have discontinued individual coverage • Federal government states it will recoup repayment as a preferred creditor of the insolvent plans • Concern that providers (as unsecured creditors) may end up getting stiffed • Litigation has begun
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