The Department of Health and Human Services offered a bulletin last week to provide guidance on how insurers should calculate actuarial value. Also, some health policy experts are beginning to question whether the health law's quality provisions might exacerbate the nation's health disparities.
Politico Pro: AV Guidance Leaves Room For States
A new HHS bulletin on how insurers should calculate actuarial value follows the pattern established by other recent health reform regulations: CMS will provide a national standard, but allow for state flexibility. Actuarial value is a measure of the share of health costs a plan covers for a standard population. The health reform law requires plans sold in the exchanges to be marketed in different tiers, based on their AV scores, so that consumers can compare benefits side by side. These range from "platinum" plans, with an actuarial value of 90 percent, to "bronze" plans, which would have an actuarial value of 60 percent. To make sure all insurers are calculating their AV scores the same way, CMS will develop its own standard population and create an "AV calculator" that will score plans based on key features of their benefit designs, the guidance explains (Feder, 2/24).
Modern Healthcare: Disparity Clarity
One of the central themes of the Patient Protection and Affordable Care Act, mentioned numerous times throughout the law, is the pressing need to eliminate health care disparities. But some health policy experts worry that provisions of the law designed to improve health care quality could exacerbate gaps in access and outcomes by penalizing the hospitals that minority and poor patients depend on the most (McKinney, 2/25).