ACA Executive Digest, 4th Issue

Washington Post Wonkbook 
As Obamacare starts, health insurers are just guessing

By Ezra Klein and Evan Soltas, Published: May 30, 2013 at 8:19 am

Welcome to Wonkbook, Ezra Klein and Evan Soltas’s morning policy news primer. To subscribe by e-mail, click here. Send comments, criticism, or ideas to Wonkbook at Gmail dot com. To read more by Ezra and his team, go to Wonkblog.

We’re in a bit of a whack-a-mole period with the Affordable Care Act’s insurance exchanges. Each week brings new data from a new state on the premiums insurers intend to charge on the exchanges. Some weeks bring revised data from old states. But it’s worth stepping back and keeping two things in mind.
The first is that all these numbers are simply guesses. Really. That’s it. California’s numbers are guesses. Maryland’s numbers are guesses. Oregon’s numbers are guesses. Vermont’s numbers are just guesses. Everyone is just guessing.
Insurers have to decide now how much they’ll charge next year. Once they’ve settled on a price and the exchanges open, that’s the end of it. They can change the price in the second year. But they can’t change it in, say, February of 2014.
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Modern Healthcare
ACA still missing key regulatory details

By Rich Daly
Posted: May 30, 2013 – 2:15 pm ET

Some key regulatory details remain unanswered in the final months before the Patient Protection and Affordable Care Act‘s major provisions launch.
Obama administration officials have insisted that they have issued all of the major regulations for the 2010 healthcare overhaul and are now focused on implementing the law’s central pillars—state health insurance exchanges and expanded Medicaid coverage—later this year. But health policy experts said they still expect important regulations implementing provisions of the law, plus a large amount of so-called subregulatory guidance.
Sam Batkins, director of regulatory policy at the conservative American Action Forum, counts 32 proposed rules that remain to be finalized, including final IRS rules on Medicare taxes and rules requiring providers to report and return Medicare overpayments within 60 days.
Other highly anticipated regulations still to come this year deal with various components of the health insurance marketplaces, experts say. Those new exchanges are expected to begin enrolling millions of private insurance subscribers in each state Oct. 1 and start providing coverage in January.
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Washington Post Wonkbook 
It’s official: Obamacare’s small-business exchange is partially delayed

By Sarah Kliff, Published: June 1, 2013 at 5:47 pm

     A few months back, the Obama administration took flak for initial plans to delay part of Obamacare’s small-business exchange.The idea, floated in regulations last month, wouldn’t put off the Small Business Health Options Program, or SHOP, altogether. Small businesses could still buy coverage for their employees on the new exchanges. What would be put off a year was an employee choice component: Rather than have each worker pick a plan, the employer would pick one insurance provider for everyone.
Those were preliminary regulations that got 40 comments from interested parties, some of whom urged the White House to rethink its decision and allow for employee choice in the first year of the exchanges’ operation.
On Friday, Health and Human Services issued its final regulation, and the delay still stands, with federal officials noting worries about getting the choice function ready to launch in less than six months.
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Bloomberg News
UnitedHealth Spurns Obama Exchanges as Rules Stall Profit

By Alex Nussbaum – May 31, 2013 6:48 AM MT

UnitedHealth Group Inc. (UNH) will offer coverage in just a dozen of the U.S. health-care law’s new insurance exchanges, in the latest sign big insurers see little gain from quickly plunging into the new markets.
The country’s largest health insurer is taking a conservative approach to the online markets set to open in states Oct. 1, Chief Executive Officer Stephen Hemsley told investors yesterday at the Sanford C. Bernstein & Co. conference in New York. The company’s plans reflect its concern that the first wave of newly insured customers under the law may be the costliest, Hemsley said. UnitedHealth Group Inc. has trimmed its plans for selling to the uninsured under President Barack Obama’s health-care overhaul, in the latest sign large insurers see little gain from quickly plunging into the new market.
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Health Reform GPS
CMS State Resources: FAQ Medicaid Eligibility Determinations, Medicaid/Exchange Interactions, and §1115 Demonstrations that Use Enrollment Caps

By Sara Rosenbaum

The interaction between Medicaid and Exchanges around eligibility determination issues represents one of the most important and complex aspects of the ACA. An estimated 28 million adults, along with 19 million children, can be expected to transition at least once annually between insurance affordability programs, as Medicaid and premium subsidies are termed under implementing CMS regulations. Collaboration between Medicaid agencies and Exchanges is essential in order to avert unnecessary delays in eligibility determinations and breaks in coverage that in turn can affect not only the affordability of care but access itself, given the link between coverage and health care access through plans’ provider networks.
On April 25, 2013, CMS issued FAQs that address issues related to Medicaid/Exchange alignment—including the availability of federal Medicaid funding for the information systems needed to support eligibility determinations
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Life Health Pro
Federal exchanges attract about 120 health plan issuers

By Allison Bell
May 30, 2013

White House officials have given “interested parties” a peek at federal Patient Protection and Affordable Care Act (PPACA) exchange plan application results in a new memo.
The 19 states with “federally facilitated exchanges” (FFEs) have attracted applications from “over 120 issuers,” officials said in the memo.
Officials did not list the issuers or say, for example, whether they are counting multiple operating companies that are owned by the same holding company separately.
Applications from carriers that want to sell medical coverage, or “qualified health plans” (QHPs), through the federal exchanges were due April 30.
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New Resources from CMS
Connecting Kids to Coverage Public Service Announcements (PSAs) Now Available!

     Medicaid and CHIP offer an extra hand to parents with their hands full! That’s the message in the new TV and radio PSAs now available in English and Spanish These 30-second spots provide the basics about Medicaid and Children’s Health Insurance Program (CHIP) eligibility and benefits, as well as information about how to apply. The Connecting Kids to Coverage National Campaign is distributing the PSAs across the country and they’ve already hit the airwaves in some communities!
There are countless ways you can use the PSAs in community settings to amplify the message about how eligible children and teens can get free or low-cost health insurance. Check out for tools to help you strengthen your efforts. CMS has provided a “pitch letter” you can use to persuade local TV and radio stations to air the PSAs, as well as “live read” radio scripts that can be customized with local information. You’ll find 10 tips on the website. Here are just a few to get you started:

Suggested Tweets:
1)      #CMS Connecting Kids to #Coverage TV & radio PSAs help eligible kids get #Medicaid and #CHIP; Download@

2)      Help eligible kids enroll in #Medicaid and #CHIP. #CMS TV & radio PSAs available in English and Spanish@

** CMS created a shortened URL to keep the character count down for tweets and provide a direct link to, the page on InsureKidsNow where the PSAs are located. **

Questions? If you have any questions about the PSAs or would like to request a playable DVD or CD, please email

More Resources 

Ramp up your outreach and enrollment efforts with the Connecting Kids to Coverage National Campaign posters and palm cards. Download the national versions or request customized versions with your local information.