Health plans don’t have the information they need to carry out some important health reform changes – and they don’t have enough time to get the work done either, the Blue Cross and Blue Shield Association says. The problem, according to the BCBSA, has to do with regulations that the Obama administration has been churning out detailing the specifics of the 2010 health care law.
The Association, which includes 39 companies that cover 98 million Americans, says its members need answers soon; they want all regulations released by the beginning of 2012.
The plans are particularly unhappy with recent regulations governing insurance exchanges, through which individuals and small businesses can buy coverage starting in 2014. Insurers need to build benefit structures and create complex health information technology systems for products that they will sell in the various state or federal-state exchanges. And, they say, they must be ready for government testing by the end of 2012.
Kris Haltmeyer, executive director of legislative and regulatory policy at the BCBSA, says developing new health plans typically takes about two years.
Haltmeyer complains that his plans cannot start investing in new information technology systems until they know what the insurance reforms are going to be, what essential health benefits package must be included in those plans, and the mechanics of how low-income tax credits will be administered.
Haltmeyer acknowledges that asking the Department of Health and Human Services to release all regulations by the beginning of 2012 is a challenge. “Given the range of things that have to be put out for comment, I’m worried they won’t be able to do that,” he said.
The Obama administration has issued a preliminary rule on the exchanges and is accepting comments. Haltmeyer says insurers still don’t have a good idea for how these marketplace hubs will function, or what will happen if some states partner with the federal government to run them. “It’s important to know what the minimum requirements for systems will be so vendors can start planning. If they issued this guidance, it would enable health plans and vendors to start building these systems,” he said.
Insurers also don’t have enough information about rules for selling coverage outside of the exchanges, which they also will be doing in 2014, said Haltmeyer.
He was also critical of a preliminary regulation that governs a new procedure to help plans that have many sick beneficiaries, establishing a transfer of funds among plans to account for the health differences of the people who sign up for insurance through the exchange. For example, if one health plan ends up with a relatively healthy population of enrollees, it may owe some money to health plans that ended up with the sickest people.
“This will have a huge impact on how we price coverage moving into 2014,” Haltmeyer said. “We need details early.”
The big question? Will health plans estimate what their enrollment will look like or take into account the actual enrollment for the year in which the risk adjustment applies, Haltmeyer said.
One administration official emphasized that it is important to get input on preliminary rules before making anything final. “If folks have concerns, or there are things they want addressed, that’s why we have a public comment period,” the official said. Already, the official added, “We hold countless meetings to hear feedback from consumers, employers, insurers, businesspeople. We take collaboration, and we take hearing what folks have to say, incredibly seriously.”
The official downplayed worries about the compressed timeline. “We’re confident the exchanges will be up and running on time and will give Americans the same kinds of insurance choices as Members of Congress,” the official said.
One reason for unanswered questions in the regs could have to do with a desire by the White House to avoid drawing public attention to differences among the three agencies involved – HHS, Treasury and Labor -- at a time when public opinion about the law continues to be split, said a former Obama administration official who asked not to be named.
But the current administration official doesn’t see good manners as a bad thing. “Only in Washington, D.C. would the idea of working together be criticized. If the idea is that we are encouraging people to be civil and to work together, then that is true.”