The Affordable Care Act (ACA) will expand access to coverage and take steps toward delivery system reform, but will raise costs and disrupt coverage for individual market customers, employers, and seniors.
Tens of millions of Americans will gain access to health insurance, a goal that health plans have long supported. The ACA also includes a number of important consumer protections that many health plans implemented before they were required by law, such as the provision allowing young adults up to the age of 26 to stay on their parents’ policies.
The new law takes a number of preliminary, but promising, steps toward reforming the delivery system to improve patient safety and quality in Medicare and Medicaid. Many of these initiatives build on successful private-sector programs that health plans have pioneered and implemented.
The ACA also includes major provisions that will raise costs and disrupt the coverage on which millions of people rely today. Many of these harmful provisions go into effect simultaneously on January 1, 2014 – meaning the potential exists for significant destabilization of insurance markets in many states, particularly for those who rely on individual and small group coverage.
Ultimately, the ACA coverage expansion will not be sustainable until policymakers and stakeholders take meaningful steps to reduce the rate of growth in medical costs.
To learn more about specific ACA provisions, please click on the links below:
Latest Documents
Press Releases
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Strategic Communications
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06/28/2012
Press Releases
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Strategic Communications
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06/12/2012
Studies from independent experts--the Congressional Budget Office (CBO), Center for American Progress (CAP), Urban Institute, Lewin Group, and RAND Corporation--have examined the impact of severing the individual mandate but retaining ACA market reforms. While the studies differ on the magnitude of the impact of severing the mandate, they all find that doing so would result in a dramatic rise in the uninsured population and increases in health insurance premiums compared to health reform with a mandate.
Infographics
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Strategic Communications
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06/07/2012
Experience in eight states that enacted various forms of guarantee issue and community rating in the 1990s all showed what happens when these market reforms are not linked to a mandate - higher premiums, no reduction in the uninsured and loss of consumer choice.
AHIP Web Resources
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Strategic Communications
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06/06/2012
New data from the Medicare Current Beneficiary Survey (MCBS) show that Medicare Advantage plans, Medicare’s private comprehensive health plans, continue to be a vital source of coverage for low-income and minority beneficiaries in 2010.
Research
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Center for Policy and Research
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05/03/2012
Press Releases
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Strategic Communications
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04/26/2012
Press Releases
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Strategic Communications
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03/23/2012
Press Releases
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Strategic Communications
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03/12/2012
Press Releases
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Strategic Communications
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02/09/2012
On January 6, 2012, AHIP and the Blue Cross Blue Shield
Association filed a brief in the U.S. Supreme Court arguing that if the
individual mandate is declared unconstitutional, then the market reforms must
be struck down as well. The brief urges reversal of the 11th Circuit
Court of Appeals’ judgment on severability, which held that the individual
mandate could be removed from the ACA, but that the market reform provisions
could remain in force.
Litigation/Amicus Briefs
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Federal
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01/06/2012
A technical analysis by Oliver Wyman estimates that the new health insurance tax in the Affordable Care Act (ACA) “will increase premiums in the insured market on average by 1.9% to 2.3% in 2014,” and by 2023 “will increase premiums 2.8% to 3.7%.” AHIP commissioned this report as part of its ongoing effort to raise awareness about the impact the tax will have on consumers, employers and public program beneficiaries.
Reports/Fact Sheets/Briefs/Talking Points
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10/31/2011
Accountable Care Organizations (ACOs) have the potential to help move the system away from the outdated fee-for-service system to one that incentivizes quality, value and better health outcomes for patients.
10/26/2011
http://www.choiceandcompetitioncoalition.org/
AHIP Web Resources
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10/01/2011
In
its letter to HHS, AHIP recommends that the ACO regulation build on
private-sector accountable care models, utilize the programs health plans have
implemented to transform the delivery system, transition away from the outdated
fee-for-service system, and avoid increasing provider consolidation and
cost-shifting that would lead to higher costs for consumers.
Comments and Letters
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06/06/2011
AHIP testimony before the House Energy & Commerce Committee’s Subcommittee on Health’s hearing entitled “The Unintended Consequences and Regulatory Burdens of the New Medical Loss Ratio Requirements”.
Testimony / Statements
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06/02/2011
Washington, DC – America’s Health Insurance Plans’ (AHIP) President and CEO Karen Ignagni today released the following statement on the rate review rule released by the Department of Health and Human Services: “Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers. The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage.
Press Releases
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Strategic Communications
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05/19/2011
The Affordable Act imposes a fee on health insurers that amounts to a de facto “health insurance premium tax” that will raise the cost of health insurance for American families and small employers. Specifically, under the law, an annual fee applies to any U.S. health insurance provider, with the intent of raising nearly $90 billion over the budget window.
Other Reports/Papers
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03/09/2011
AHIP filed a policy-oriented amicus brief in the US Court of Appeals for the 4th Circuit that reiterates our longstanding position that the guarantee issue and community rating provisions of the Affordable Care Act (ACA) are inextricably linked to the law’s personal coverage requirement. The decision in the District Court struck down the individual mandate, but left the market reforms in place—a situation which experience in the states has demonstrated would have severe unintended consequences for consumers.
Litigation/Amicus Briefs
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03/07/2011
AHIP’s letter to HHS on the proposed rate review regulations states that rate review should continue to be done at the state level and should take into account all of the factors driving premium increases, including soaring prices for medical services, new benefit mandates, and changes in the risk pool.
Comments and Letters
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02/22/2011
AHIP’s letter to HHS raises concerns that the medical loss ratio requirement could disrupt coverage, reduce patients’ access to quality improvement initiatives, and increase administrative costs.
Comments and Letters
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01/31/2011
Former Director of CBO Doug Holtz-Eakin testified before a House Ways & Means Committee hearing that the tax increase on health insurance premiums will be passed on to consumers with American families paying as much as $135 billion in higher premiums over the next 10 years.
Testimony / Statements
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01/26/2011
Testimony from Carmella Bocchino, Executive Vice President of Clinical Affairs and Strategic Planning for AHIP, who participated on a panel discussion at the Institute of Medicine’s (IOM) meeting on the determination of essential health benefits.
Comments and Letters
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01/13/2011
America’s Health Insurance Plans’ (AHIP) President and CEO Karen Ignagni today released the following statement on the proposed rate review rule released by the Department of Health and Human Services
Press Releases
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Strategic Communications
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12/21/2010
New data from the Medicare Current Beneficiary Survey (MCBS) show that Medicare Advantage plans, Medicare’s private comprehensive health plans, were a vital source of coverage for low-income and minority beneficiaries in 2008.
Research
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Center for Policy and Research
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12/06/2010
In
an effort to assist policymakers, regulators, providers, health plans, and
others in considering the rules and regulations that are being formulated for ACOs,
AHIP hosted a forum on ACOs on September 23, 2010, in Washington, DC that
included a panel of four experts who provided guidance on the implementation of
the Shared Savings Program and discussed various aspects of market power
and antitrust concerns as they relate to ACOs.
This paper summarizes the key lessons and themes discussed by the
presenters as well as the participants.
White Papers
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10/20/2010
AHIP submitted comments to the National Association of Insurance Commissioners (NAIC) raising concerns that the MLR provision could disrupt the coverage families and employers rely on and turn-back-the-clock on quality improvement initiatives.
Comments and Letters
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10/13/2010
AHIP
letter to HHS summarizing our recommendations on how to develop health insurance
exchanges that maximize choice and competition for consumers.
Comments and Letters
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10/04/2010
Heritage Foundation backgrounder on the impact of new Medicare Advantage cuts included in the ACA, which states that these cuts “will restrict senior citizens and the disabled to fewer and worse health care choices, reducing their access to quality health care.”
Other Reports/Papers
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09/14/2010
Both
the public and private sectors are exploring and implementing innovative care
and payment models designed to improve delivery of care and encourage Americans
to stay healthy. This white paper examines
the concept of Accountable Care Organizations (ACOs), often defined as
organizations of health care providers that agree to be held accountable for the quality, cost and overall
care for a defined population of patients and that seek to receive shared
savings if they meet certain quality and costs goals.
White Papers
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09/13/2010
This Hay Group presentation provides an overview of how health insurance premiums are calculated and the factors that contribute to premium increases.
Other Reports/Papers
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07/20/2010
AHIP’s letter to HHS on the proposed rate review regulations states that rate review should continue to be done at the state level and should take into account all of the factors driving premium increases, including soaring prices for medical services, new benefit mandates, and changes in the risk pool.
Comments and Letters
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05/14/2010
The Centers for Medicare and Medicare Services Chief Actuary Rick Foster released an analysis of the Patient Protection and Affordable Care Act, which concluded that cuts to Medicare Advantage would “result in less generous benefit packages” and that MA enrollment would be 50 percent lower than previous projections.
CMS Letters of Guidance
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04/22/2010
AHIP President and CEO Karen Ignagni testified before the Senate HELP Committee on the soaring cost of medical care and its impact on health insurance premiums.
Testimony / Statements
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04/20/2010
Washington, D.C.
Press Releases
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Strategic Communications
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03/30/2010
The Congressional Budget Office released its latest projections on the impact new cuts to Medicare Advantage will have on the millions of seniors enrolled in the program. CBO is projecting MA enrollment will decline from 11.7 million enrollees in 2011 to 7.5 million in 2018.
Other Reports/Papers
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03/19/2010
Press Releases
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Strategic Communications
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03/18/2010
Oliver
Wyman has developed an actuarial model to study the impact of different reform
proposals on the individual and small employer health insurance market. According to this model, if the age band is
compressed to 3:1, premiums for the youngest-healthiest third of individuals
would be 35% higher in Year 1 compared to reform with 5:1 rating bands.
Other Reports/Papers
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09/28/2009
AHIP’s proposal offers a
new set of proposals aimed at moving the nation toward
a restructured health care system in which no one falls
through the cracks, all Americans have high quality,
affordable coverage, and the efficiency and
effectiveness of the system are greatly improved. The
comprehensive proposals has four specific objectives:
controlling costs, adding value, helping consumers and
purchasers, achieving universal coverage.
AHIP Health Care Reform Proposals
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12/01/2008
AHIP’s proposal offers a new set of proposals aimed at moving the nation toward a restructured health care system in which no one falls through the cracks, all Americans have high quality, affordable coverage, and the efficiency and effectiveness of the system are greatly improved. The comprehensive proposals has four specific objectives: controlling costs, adding value, helping consumers and purchasers, achieving universal coverage.
AHIP Health Care Reform Proposals
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12/01/2008
AHIP’s proposal outlines five principles to make health care more affordable: Give patients and their doctors the information and tools they need to make the best health care decisions; create an efficient, interconnected health care delivery system that reduces medical errors; give doctors and nurses the freedom to practice medicine without worrying about frivolous lawsuits; transition to a system that more closely aligns payments with the quality of care patients receive; and move towards a system of care that focuses on keeping people healthy, detecting disease at the earliest possible stage, and rewarding chronic care management.
AHIP Health Care Reform Proposals
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06/01/2008
AHIP’s proposal outlines five principles to make health care more affordable: Give patients and their doctors the information and tools they need to make the best health care decisions; create an efficient, interconnected health care delivery system that reduces medical errors; give doctors and nurses the freedom to practice medicine without worrying about frivolous lawsuits; transition to a system that more closely aligns payments with the quality of care patients receive; and move towards a system of care that focuses on keeping people healthy, detecting disease at the earliest possible stage, and rewarding chronic care management.
AHIP Health Care Reform Proposals
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06/01/2008
Health insurance plans
stand ready to work with policymakers to guarantee
access to health insurance to all who seek coverage in
the individual market. At the same time, AHIP is
recommending a series of reforms to give consumers
peace of mind, including limiting the use of
pre-existing condition exclusions, restricting
rescission actions, and establishing a new third-party
review process for pre-existing conditions and
rescission decisions.
AHIP Health Care Reform Proposals
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12/15/2007
AHIP’s proposal recommends a series of reforms to give individuals peace of mind about their individual market coverage, guaranteeing access to coverage regardless of health status or income.
AHIP Health Care Reform Proposals
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12/03/2007
A report by Milliman, Inc. examined the impact of enacting guarantee issue and community rating without covering everyone. According to the report, these initiatives have the potential to cause individuals to wait until they have health problems to buy insurance. This could cause premiums to increase for all policyholders, increasing the likelihood that lower-risk individuals leave the market, which could lead to further rate increases. If this continues, the pool or market could essentially collapse or shrink to include only the high-risk population.
Other Reports/Papers
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08/30/2007
In November 2006, AHIP
introduced a comprehensive proposal to extend health
insurance coverage to all Americans-- because we
believe every American should have access to affordable
health care coverage. Now, in 2007, we are proposing a
framework for an equally crucial step: ensuring that
any serious and sustainable effort to extend coverage
is accompanied by significant improvements to the
quality and safety of health care.
AHIP Health Care Reform Proposals
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04/15/2007
AHIP’s proposal supports innovation by advancing independent analysis of which procedures and technologies work best; improves clinical quality by improving dissemination and transparency of information on safety, effectiveness, and performance; and better protects patients by resolving disputes faster, fairly, and more effectively.
AHIP Health Care Reform Proposals
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04/02/2007
AHIP’s proposal would strengthen the health care safety net, give working families a helping hand to afford coverage, and provide support to states that enable all of their citizens to have coverage.
AHIP Health Care Reform Proposals
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11/01/2006
This proposal
establishes a federal framework through which states
are given incentives to expand health insurance
coverage. It is built on a partnership among the
federal government, states, employers, and individuals
with the private and public sectors working together to
achieve access to health insurance coverage for all
Americans. We stand ready to engage in a dialogue with
the federal and state governments and with other
stakeholders to advance these policies and to work to
provide access to all of the uninsured Americans.
AHIP Health Care Reform Proposals
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11/01/2006
Older patients typically utilize more and higher cost health care services than younger patients. One way states can ensure that coverage remains affordable for everyone is to support the use of age rating bands that spread premium costs over a range of age groups. For example, in a state with a 5:1 age band, the ratio limits the amount an older individual will pay to no more than five times what a younger individual pays in premium dollars.
The ACA requires health plans, beginning in 2014, to provide a certain set of minimum benefits similar to what employers typically offer today. The law outlines 10 general categories of benefits that are to be used as a benchmark when determining what qualifies as an “essential health benefits package.” These categories go beyond the coverage that many individuals and small businesses purchase today – meaning millions of Americans will have to “buy up” to purchase more coverage than they currently have. Further expansion of the essential health benefits requirement will result in less affordable coverage for individuals, families and small employers by forcing them to “buy up” and purchase more coverage than they may want or need.
Health plans have long supported exchanges as one option among many to provide consumers with access to innovative plan choices and clear and consistent information that can help aid decisions about all coverage options. Under the new law, individuals and small businesses will have access to new exchanges starting in 2014. The ACA outlines a set of federal requirements for state-based exchanges, and if a state chooses not to set up an exchange, consumers in the state will have access to a new federal exchange.
The ACA requires health insurers in the individual and group markets to provide coverage on a “guarantee issue” basis without any pre-existing condition exclusions—which could create an environment where individuals wait until they are sick to obtain coverage absent strong incentives to assure that everyone participates in the marketplace. States that have enacted similar approaches have seen significant premium increases, less competition and a loss of consumer choice. To counter-balance some of the effects of this and other insurance market reforms, the ACA also includes a requirement that all Americans carry basic health insurance. Yet many experts question whether the coverage requirement will be sufficient to encourage younger and healthier people to take up coverage. In fact, the penalty for failing to carry insurance in 2014 will be as low as $95.
The broad market reforms outlined in the ACA take effect on January 1, 2014. Individuals and families purchasing insurance in the individual market will be guaranteed coverage for pre-existing conditions, and their premiums cannot vary based on their gender or medical history. There will also be subsidies to help consumers afford the cost of coverage, and new state-based health insurance exchanges will help consumers find the policies that best meet their needs.
The ACA requires a new federal cap on health plan administrative costs that could have a number of unintended consequences for individuals, families and employers.
Medicare Advantage is the part of Medicare through which private health plans provide comprehensive medical coverage to seniors and other Medicare beneficiaries.
Almost 12 million Americans, or roughly 25 percent of all Medicare beneficiaries, have chosen to enroll in a Medicare Advantage plan because of the better services, higher-quality care and additional benefits these plans provide.
The ACA includes a weak coverage requirement that will encourage people to wait to purchase coverage until after they are sick, which unfairly penalizes those who currently have coverage.
Beginning in 2014, the ACA requires health plans to pay a new sales tax on policies sold to individuals, working families, small businesses and seniors. The tax begins at $8 billion in 2014 and rises to $14.3 billion in 2018.
Many experts agree that focusing solely on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable. The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, public safety net and the affordability of coverage.
Studies on Hospital Readmissions, Featuring Health Plan Innovations and Comparisons of Medicare Advantage (MA) and Medicare’s Traditional FFS Program.
Research
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Center for Policy and Research
In September 2011, AHIP conducted a survey of health insurance plans on costs of compliance with the new Summary of Benefits and Coverage (SBC) and the Uniform Glossary requirements detailed in a notice of proposed rulemaking (NPRM) issued by the Department of Health and Human Services (HHS), Department of Labor, and Department of Treasury on August 22, 2011.
Research
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Center for Policy and Research
The Coalition for Medicare Choices is a rapidly growing organization of Medicare Advantage beneficiaries. More than 1.4 million Americans in 50 states have joined the Coalition to protect the benefits they receive through their Medicare Advantage plan. Together, we are working to show Congress that Medicare Advantage plans provide critical benefits and lower out-of-pocket costs to millions of beneficiaries. As Congress debates potential changes to Medicare Advantage, we will make certain that your voices are heard. The Coalition for Medicare Choices is administered by America's Health Insurance Plans, the national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans.
AHIP Web Resources
Milliman examined states that enacted guaranteed issue and community rating reforms in the absence of an individual mandate, and found that they saw their individual insurance markets deteriorate. This report updates Milliman’s August 2007 report on the impact of guaranteed issue and community rating (CR) reforms adopted in eight states in the 1990s.
Other Reports/Papers