6 Health Reform Issues Loom over Plan Sponsors in 2012

Image source: hr3590.com

After so much ink spilled and heartache over health reform, plan sponsors might think the dust has settled and say: “The coast is clear. We can come out of hiding.” But if you thought that all this effort has totally clarified health reform (and if you think you know just what to do to comply), you’d be mistaken, sadly mistaken.

The dreadnought of health reform is inexorably advancing, and even though 2012 is not a big implementation year (like 2014 will be), plan sponsors have some important “watching and seeing” in the coming year. According to attorneys Adam Russo and Ron Peck with the Phia Group in Braintree, Mass., here are some of the top reform items looming right ahead for self-insuring health plan sponsors.

1. Raise limits on essential health benefits. Plans will have to raise annual limits on essential benefits (as defined by reform rules) to $2 million starting Sept. 23, 2012. That’s up from $1.25 million in effect now.
2. Whither Accountable Care Organizations? Plans will also watch what Medicare does with “accountable care organizations,” a care coordination initiative that incentivizes affiliated providers to reduce costs by letting them share in the savings. If it succeeds in Medicare, this approach might move into the private-insurance relationship.
3. New fees on self-funded plans. 2012 won’t be the year plans have to pay new fees to fund comparative effectiveness research. But it will be the year plans learn the frequency and method of calculating the fees they will have to start paying in 2013.
4. Summaries of benefits and coverage (SBCs). Similarly, plans won’t have to start issuing SBCs to participants until 2013 (thanks to government delays figuring how to squeeze all their required information in the allotted space), but in 2012, many will want to watch how SBC rules develop, so they know how to satisfy that requirement when it comes live.
5. Will regulators shackle stop-loss? In October 2011, an analyst for the National Association of Insurance Commissioners recommended that stop-loss coverage be prohibited to small groups, and that stop-loss policies with low attachment points be abolished. 2012 will be a showdown year on this issue, with the fate of self-insuring (as an alternative to full insurance, and policies bought on state exchanges) in the balance.
6. Will reform even survive? Of course, no list would be complete if we didn’t mention the fact that 2012 is the year the U.S. Supreme Court decides on whether health reform’s individual mandate remains or gets struck down. The High Court has seen decisions from the 4th, 6th and 11th U.S. Circuit Courts of Appeals on this issue. If the court rules that the individual mandate is unconstitutional, that could have a domino effect on the employer mandates in the reform law.