ACA Title 1, Sec. 1304. Related definitions. ‘Good” – Defines individual and group markets and large and small employers.This section simply defines the basic terms including “Individual Market” and “Group Market” and the terms “Large Employer” (101+ employees) and “Small Employer (≤100 employees) and transitional rules for their treatment as they grow or change. States… Continue Reading ›

ACA Title 1, Sec. 1303. Special rules: “Bad”- Identifies special ground rules for handling abortion services. This provision provides general protections for consumers to have access to health plans through exchanges that cover abortion services. It also protects state laws from preemption by federal laws and established ground rules for public funding of abortion services. It… Continue Reading ›

ACA Title 1, Sec. 1302. Essential health benefits requirements: “Bad”- Too comprehensive and wasteful. This provision establishes the set of benefits and maximum out-of-pocket (MOOP) cost sharing limits that will now apply across all qualifying insured plans. It includes a broad range of benefits by category and on the good side includes a new provision for… Continue Reading ›

ACA Title 1, Sec. 1301. Qualified health plan defined: “Good” – a “good housekeeping-like seal of approval”. This section establishes a class of health plans offered by exchanges that are called “qualified health plans” which are really like the old “good housekeeping seal of approval” to provide an easy third party qualification for health plans.… Continue Reading ›

ACA Title 1, Sec. 1253. Effective dates: “Good” – with enough time for advance planning. This provision makes the proposed changes in this subtitle effective for all health plans with anniversary dates beginning on or after January 1, 2014. This provides a reasonable amount of time for employers and health plans to adjust to the… Continue Reading ›

ACA Title 1, Sec. 1252. Rating reforms must apply uniformly to all health insurance issuers and group health plans: “Good” leveling the playing field. This provision establishes a “level playing field” for all plans in a given marketplace. This is likely to prevent “cherry picking” through manipulation of premium rates. Combined with the other standardization… Continue Reading ›

ACA Title 1, Sec. 1251. Preservation of right to maintain existing coverage: “Good” – but somewhat moot. This provision provides a semblance of protection for health plan coverage that existed at the time of the enactment of the Law (March 23, 2010). These health plans are considered “grandfathered health plans”. As long as employers and… Continue Reading ›

ACA Title 1, Sec. 1201 Amendment to the Public Health Service Act: 2 “Uglies”, 3 “Bads” and 3 “Goods” This section includes several important policies that will have far-reaching implications and effects on the health insurance industry. Each of these are reviewed in turn. Sec. 2704. (SIC) Prohibition of preexisting condition exclusions or other discrimination… Continue Reading ›

ACA Title 1, Sec. 1005 Effective date: “Bad” – Should have used regulation process: This section does what most of the sections in ObamaCare do: they hurry this historical undertaking into action prematurely and with great haste. The problems with the Healthcare.gov website are indicative of the general haste embedded in the Law by democrats… Continue Reading ›

ACA Title 1, Sec. 1104 Administrative simplification. “Bad” – Extends HIPAA standardization too far: This section extends the standardization of all claims, patient care, electronic claims payment procedures and health plan reporting provisions originally contained in HIPAA. This looks like more extensive standardization of “operating rules” with sizable financial penalties for non-compliance. This feels like… Continue Reading ›