As the Patient Protection and Affordable Care Act approaches its one-year anniversary, the focus on the law is shifting from the issues of extending coverage and insurance reforms to the structure of the upcoming insurance exchanges, accountable care organizations and the definition of "essential benefits."
Speakers at last week’s National Congress on Health Insurance Reform in Washington noted the shift, particularly Karen Ignagni, president and CEO of America’s Health Insurance Plans, who voiced AHIP’s concerns over ACOs, essential benefits and exchanges.
While AHIP is “very supportive” of the concept of coordinated and accountable care, Ignagni expressed concern about the potential for cost shifting under an ACO structure. Also, according to Ignagni, both horizontal and vertical consolidation by ACOs have resulted in higher costs and greater demands being placed on hospitals.
"We’re very concerned as we look at the ACO regulations,” she said. “Will they inadvertently encourage more consolidation both horizontally as well as vertically, and what will be the consequence from a cost perspective in the market, as well as from a quality perspective?"
There are two issues that must be carefully looked at when it comes to defining "essential benefits," said Ignagni. The first is the differences among individual, small and large group packages, which must be disaggregated, she said. If the essential benefits package is close to or mirrors the large-group arena, Ignagni warns that small-group and individual purchasers will be forced to “buy up."
The second issue is providing information to the Institute of Medicine — which is conducting a study on what constitutes essential benefits — on tools the industry is using to improve quality, transparency and reduce costs. “A range of strategies are being used in the delivery system today; the idea here is to end up with a structure that allows these tools to continue to be used,” Ignagni said.
As for the state health insurance exchanges that must be in place by Jan. 1, 2014, AHIP is working at the state and national level to ensure that consumers have a wide variety of easily comparable, transparent choices, said Ignagni. “We are working very hard at the state level as well as in D.C. to make sure that there are opportunities for choice and competition,” she said. “That’s our objective.”
Meanwhile, Republicans in the House of Representatives begin a series of hearings on PPACA today, with a Ways and Means Committee hearing examining the impact of the law’s taxes, regulations and mandates on jobs, employers and the economy.
"This hearing provides us the opportunity to directly hear from employers about the higher taxes and new mandates that are in this law," said Committee Chairman Dave Camp (R-MI) prior to the hearing. "This will also serve as a basis for how this committee, and Congress, can best respond to the concerns of employers and workers and refocus its energy to develop common sense solutions that prioritize affordability and jobs."