Insurance Companies Moving Forward with Affordable Care Act

Although public reaction the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) has been mixed, four years after its passage, insurance companies are moving forward under its framework. Around the country, insurance companies are looking to expand their offerings to consumers through private, state and federal Exchanges.

  • Georgia. During the 2014 open enrollment period, insurance was offered by five companies on Georgia’s state Exchange. Currently seven insurance companies will be offering coverage on Georgia’s Exchange for the 2015 open enrollment period. Notably missing are United Healthcare and Cigna, two of the nation’s top providers. However, recent reports indicate that United Healthcare is considering joining the state’s Exchange. United currently only offers insurance on five state exchanges. Advocates of the ACA argue that with more companies offering coverage in each state, consumers are given a wider variety of options and more competitive prices.


  • Illinois. Ten insurance companies in Illinois have submitted a total of 504 plans for approval to the state Department of Insurance. Approved plans will then be offered on the state’s Exchange during the 2015 open enrollment period. For the 2014 open enrollment period, eight companies offered a total of 165 plans in Illinois. During the 2014 open enrollment period, approximately 92 percent of th 217,000 people who purchased insurance bought a plan through Blue Cross Blue Shield of Illinois.


  • Nationally. The national trade organization America’s Health Insurance Plans, or “AHIP”, is pressing the government to “enhance affordability” by allowing lower premium catastrophic plans for families to be sold on the Marketplace. According to AHIP, “We believe a new catastrophic plan would further the public policy goal of affordability and call upon policymakers to expand consumer choices by allowing this lower-premium option to be offered.” Currently catastrophic plans are only available to a select group of individuals.


  • Private exchanges. Reports indicate approximately three million Americans purchased health insurance for 2014 on private Health Insurance Exchanges. Private exchanges are run by corporations and can also referred to as “defined contribution” coverage. In Oregon, Regence BlueCross BlueShield of Oregon recently launched “Regence Marketplace” for Oregon businesses to consider, along with this explanatory marketing video:

Some reports estimate that by 2018, enrollment on private exchanges will surpass federal and state Exchange enrollment. Bain & Co. estimates that up to 80 million Americans will get their insurance from private exchanges by 2018.

Highlight on New Hampshire: Marketplace and SHOP Updates

Four insurance companies will be joining New Hampshire’s state Exchange and will offer health insurance plans to state consumers on the Marketplace beginning with the next open enrollment period, November of 2014. Assurant Health, Harvard Pilgrim Health Care of New England, and Minuteman Health (a Massachusetts-bsed co-op) will join Anthem Blue Cross Blue Shield, which was the only company offering plans on the Marketplace for plan years beginning in 2014. Proponents of the additions argue that more competition will lead to more competitive prices for consumers.

New Hampshire runs a Partnership Marketplace with the federal government, which was approved by Secretary Sebelius in March of 2013. In order to maintain the Partnership Marketplace the state must:

  • Demonstrate the ability to perform all required Exchange activities in line with the attestations it made in its Exchange Blueprint Application Submission; and
  • Comply with regulations and expected progress milestones.

As of April 19, 2014, over 40,000 individuals enrolled with a private plan through the state’s Exchange, and another 7,235 were eligible for Medicaid coverage. The original projection for the state’s 2014 enrollment was 19,000. An overview of the state’s Exchange process can be seen here.

In addition to broadening the choices in the individual Exchange, the state recently closed a comment period that requested opinions on whether or not it is in the best interest of the state’s small group health insurance market to include the employee choice functionality in New Hampshire’s federally operated Small Business Health Options Program (SHOP) during 2015, or if it should delay the functionality until 2016. The comment period was in response to the CMS Final rule on the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) Exchange and Insurance Market Standards for 2015 and Beyond (78 FR 30240).

“Healthy Incentives” Wellness Program Saves County $46 Million Over Five Years

A Seattle area program entitled “Healthy Incentives” that has saved King County $46 million on employee health care since 2006, won the 2013 Innovations in American Government Award, which is bestowed by The Ash Center for Democratic Governance and Innovation at the John F. Kennedy School of Government at Harvard University. The award was established in 1985 by the Ford Foundation to honor government agencies at any level that work to improve the quality of life of citizens.

Healthy Incentives

The Healthy Incentives program has saved King County taxpayers millions of dollars in county employee health care costs. The benefit plan rewards employees with lower out-of-pocket expenses for choosing high quality healthcare plans while participating in wellness activities. The program was created after the realization that employee healthcare costs were rising at a rate three times higher than the Consumer Price Index. The program is credited with:

  • More than 800 individuals quitting smoking
  • Over 2000 individuals classified as overweight or obese have lost at least 5 percent of their weight
  • Fewer health claims for pneumonia, bronchitis and other illness associated with smoking
  • $46 million savings from 2007-2011, with $14.6 million attributed to health improvements of employees

The program has seen a participation rate of 90 percent or higher since its inception. When compared with national averages, participants in Health Incentives lost more weight and smoked less.

Wellness Programs

Although Health Incentives was created before the passage of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), the ACA had multiple provisions to better understand and help employers utilize wellness programs in an effort to reduce cost and increase overall health. Among other things, the ACA provided for a Centers for Disease Control study and evaluation of employer-based wellness programs (sec. 4303), provided for financial grants to small employers with comprehensive workplace wellness programs (sec. 10408), and directed the Secretary to evaluate community-based prevention and wellness programs to develop a plan for Medicare beneficiaries (sec. 4202). In 2013 HHS released a final rule to assist group health plans and health insurance issuers with offering nondiscriminatory incentive programs (Final Rule, 78 FR 33158, June 3, 2013). Discrimination based on health status is prohibited by the ACA. Speaking with Wolters Kluwer, Brooke Bascom, the Healthy Incentives Health Reform Program Manager, noted that the program was designed to reward participation in the program and was not results-based. “It might take seven times to quit smoking and we want to reward someone every time they try,” said Bascom.

The King County Healthy Incentives program has an online Toolkit designed to assist other entities with replicating the program. The Toolkit provides an overview of the program, information on its design, information on partnership with the labor force including a Memorandum of Agreement between management and labor, employee outreach strategies, and measurement and evaluation of the program. Speaking with Wolters Kluwer, Daniel Harsha, Associate Director for Communications at the Ash Center for Democratic Governance and Innovation stated that one of the reasons Healthy Incentives was selected for recognition was the fact that it “served as an important model for other municipal and state governments across the country who are struggling with how to contain rising employee healthcare costs.” Overall the Harvard Ash Center analysis felt the program was well suited for replication.

Report Gives Almost All States a Failing Grade on Price Transparency

The 2014 Report Card on State Price Transparency Laws has been released by the Health Care Incentives Improvement Institute (Institute), providing a resource for policy makers, consumer advocates and health care leaders to access health care prices in every state across the country. Noting that the inaugural report in 2013 gave many states a failing grade, the Institute nonetheless “raised the bar” and further researched state laws, state price transparency regulations, price transparency websites, and all-payer claims databases for the 2014 report. The Institute did not factor “voluntary price transparency websites” into its grade, websites that are hosted by hospital associations, foundations or nonprofits, because they are dependent on the “good will and resources of the organizations that hosts them.”


The Institute reviewed: (1) state-specific laws focused on transparency for health care; (2) related state regulations regarding price transparency; and (3) state-mandated price transparency websites, with each state getting an overall grade based on the 3 components. Numerous sub-factors influenced the final grade, with points earned by states for various specific criteria relating to the website’s ease of use, utility, scope and accuracy. The overall review generated six resources, including a report card giving each state a letter grade, reference tables and an appendix with information on voluntary websites to give states a sense on how their websites measure up against others. The Institute also looked at laws and regulations relating to the all-payer claims databases (APCDs) which provided a more in-depth analysis than the inaugural report.

State Findings

Maine and Massachusetts received the highest grade, both earning a “B.” Colorado, Vermont and Virginia earned “C” grades while the remaining states were given an “F.” Among the states with an “F” grade, fluctuations occurred in scores among the sub factors. For instance, Arkansas was given a “poor” rating for utility, ease of use and scope, and an “average” rating for accuracy of the data. Illinois received a “poor” rating for all four sub-factors, while Florida received a “good” for ease of use, an “average” for accuracy of data, and “poor” for the remaining sub factors. Most of the voluntary websites were also given “F” grades, with Minnesota receiving the highest grade of “C.”