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Life Health > Health Insurance

3 PPACA World field reports

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The Patient Protection and Affordable Care Act (PPACA) public exchange system has been up and moving for about a year.

The PPACA Summary of Benefits and Coverage (SBC) provision and other notice provisions have been here longer than that, and we’re now more than three weeks into the second annual exchange plan enrollment period.

Some benefits industry veterans have looked at PPACA World in the past few weeks and sent use reports about they’ve seen.

To learn more about their observations, read on.

Complicated roads

1. Nothing has gotten any simpler

One goal of the PPACA drafters was to cut health care system costs by easing administrative complexity.

Representatives from the UnitedHealthcare unit of UnitedHealth Group (NYSE:UNH) tried to give us a simple description of what’s been happening in one small corner of PPACA World — the dental and vision insurance market — and ended up taking several hundred words just to describe the new distribution channels that are now available.

PPACA requires basic pediatric vision and dental benefits to be part of the essential health benefits (EHB) package that major medical plans are supposed to try to cover.

In practice, UnitedHealthcare reps said, all of the health plans sold through the new PPACA exchanges do include coverage for an annual routine pediatric eye exam and basic annual pediatric eyewear purchases.

The picture for pediatric dental benefits is less clear.

The UnitedHealthcare reps said their company sells coverage through traditional channels; through the public exchange system; through independent private exchanges; through its own private exchange system; and through an exchange-like multi-plan choice product it developed in 2008.

A few weeks ago, officials at the Centers for Medicare & Medicaid Services (CMS) made headlines when they reported that they had accidentally added dental enrollment to major medical enrollment when they had said the exchanges ended August with about 7.3 million enrollees.

Republican critics of the PPACA exchange plans accused CMS officials of intentionally using the dental enrollment figures to inflate the major medical enrollment total, to get over the 7 million-enrollee goal included in Congressional Budget Office (CBO) office projections.

Some of the 6.3 million exchange plan enrollees may have gotten dental coverage from another source, but supporters of the goal of getting access to basic dental coverage noted that the CMS figures may mean that fewer than 10 percent of exchange plan enrollees have ready access to basic dental coverage.

See also: Keep Boomers Smiling (With Their Own Teeth)


2. Even the “simple parts of PPACA” can be annoying

One of the relatively noncontroversial provisions of PPACA has been the part that created the SBC — the “nutrition label for health plans.”

Nutrition labels don’t satisfy everyone, and SBCs don’t either, but survey firms have found that even Republican voters who hate PPACA generally like the SBC concept.

Emma Hoo, director at the Pacific Business Group on Health, said that, although the large employers her group represents respect the goals of the SBC program, the SBC requirements do contribute to the growing mountain of administrative burdens.

Large employers also find the SBC program somewhat limited, Hoo said.

“Apples to apples comparisons are generally helpful, but the static SBC notice requirement overlooked the fact that many large employers already use decision support tools and information portals that summarize plan information electronically and allow users to generate tailored benefit comparisons,” Hoo said.


3. The off-exchange market is still here

One concern among traditional group benefits brokers has been that their bread-and-butter clients — small groups — might either flock to PPACA Small Business Health Options Program (SHOP) plans, or dump their own plans and send workers to go get their coverage from the individual exchange system.

Ron Goldstein, the head of the company that runs the CaliforniaChoice private small-group exchange program, said he has seen no such trend.

In theory, the kinds of employers that are already using CaliforniaChoice might be the kind that would be open to doing business with the Covered California PPACA exchange, especially now that the public exchanges have been around for a year.

In the real world, “from our perspective, and in speaking with the brokers we work with, we are not seeing small groups going to the exchange for subsidies,” Goldstein said.

CaliforniaChoice has enjoyed incredible growth this year and is looking forward to more opportunity in 2015, Goldstein said.

See also: 5 ways small-group exchange plans went wrong


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