The new regulations on which insurance plans would be considered “grandfathered” under the new health law has prompted diverse responses from bloggers. In addition, there’s a posting about the difficulty of using research to tailor Medicare treatments and studies on health sector productivity.
Health Affairs’ Timothy Jost, a legal scholar, takes a detailed look at the proposed regulations:
The regulations begin with the statutory principle that as long as an enrollee remains with a plan in which the enrollee was a member on March 23, 2010, the terms of that plan do not need to change to accommodate requirements of PPACA that do not apply to grandfathered plans. Insurers or employers may add new benefits to health plans, change the terms of a plan to comply with state or federal requirements (including PPACA requirements that apply to grandfathered plans), voluntarily adopt consumer protections that they are not required to adopt, make modest adjustments in benefits or cost sharing, and — most importantly – raise premiums, without losing grandfathered status.
Grandfathered plans may also add new family members or employees, and may be renewed. Indeed, a grandfathered group plan could add new employees as existing employees left the plan, ending up eventually with no members who were enrollees as of the effective date, but still remain grandfathered. The regulations, however, bar certain subterfuges that employers may be tempted to engage in to maintain grandfathered status.
Heritage’s Kathyrn Nix continues her “side effects of Obamacare” series with a look at the new regulations. Nix says, “The new regs will make it tough for a lot of those folks to hold onto their current plans, even though the Department of Health and Human Services continues to claim otherwise. That because HHS is ready to revoke the ‘grandfathered’ status of existing plans whenever an employer makes what it deems to be a ’significant’ change in terms of coverage. And the HHS regs show that common adjustments such as an increase in deductibles or co-pays or a reduction in benefits would be considered ’significant.’”
The Apothecary’s Avik Roy says “The government also provided a low estimate and a high estimate; at the high end, the report projects that 80% of small employers, and 69% of all plans, would lose their status by 2013.” Roy also points to another blog that suggests unions might be exempt from the grandfathering rules until their next contract negotiations.
Wonk Room’s Igor Volsky has a different take: “The new grandfathered rules wouldn’t prevent plans from changing. They would only discourage employers and insurers from stiffing beneficiaries with very higher costs and insufficient benefits or increasing costs and reducing benefits too quickly. To argue that grandfathering would force people out of their plans assumes that market forces aren’t already pushing people out of existing coverage or leading to significant cost increases and benefit reductions.”
And Dawn Horner of Georgetown University’s Say Ahhh! writes: “With the new rules in place, however, these millions of children and families will be assured that they receive the same protections under health reform as others newly signing up for coverage. Now that’s something to tell our grandchildren about!”
Elsewhere, Merrill Goozner looks at a Wall Street Journal report about research showing that Medicare could save up to $500,000 per year by changing beneficiaries’ drug treatment for macular degeneration. However, Goozner notes, “CMS will still cover [the more expensive drug] Lucentis after the ‘definitive’ trial results are published because it is prohibited by law from using comparative effectiveness research or cost-benefit analysis to make coverage decisions.”
The Association of Health Care Journalists’ Andrew Van Dam points to a new study from the Agency for Healthcare Research and Quality that he says is full of colorful graphs and attempts “to figure out where to put the blame for those in-patient cost jumps that occurred between 2001 and 2007 and thus divided the increases into four categories: Medicare, Medicaid, private insurance and payments from those without insurance.”
The Incidental Economist’s Austin Frakt looks at a new paper from economist David Cutler that found productivity growth in health care, education and other social services was negative betweeen 1995-2005. Frakt reacts: “This is not a good sign. To have any hope of obtaining a reasonable return on our massive health care (and other social program) spending, we need productivity in the sector to grow, not shrink. If the 1995-2005 trend continues, we risk both the health of our economy and populace.”