March 14, 2013


There may be gridlock in Congress and with the President, but the regulators have been busy. Particularly on health care.

Here is a sampling of the recent health care regulations:

Application for health care benefits:  Applying for benefits under the Affordable Care Act “could be as daunting as doing your taxes.” The Associated Press notes, “Drafts of the paper application and a 60-page description of the online version were quietly posted online by the Health and Human Services Department, seeking feedback from industry and consumer groups. Those materials, along with a recent HHS presentation to insurers, run counter to the vision of simplicity promoted by administration officials.” AP (3/12, Alonso-Zaldivar)

What must be in a health insurance policy? “The Department of Health and Human Services released its long-awaited final rule on essential health benefits today, allowing insurers and states to move forward on both the federal and state health exchanges.” In a report accompanying the report, HHS wrote, “Americans accessing coverage through non-grandfathered plans in the individual and small group markets will now be able to count on mental health and substance use disorder coverage that is comparable to their general medical and surgical coverage.” USA Today (2/21, Kennedy).

Employer mandate regulations: “The IRS moved forward Friday on implementing the employer mandate in President Obama’s signature healthcare law, which requires most businesses offer health benefits to their workers.” Under the regulations, “Businesses that don’t offer insurance will have to pay a penalty of $2,000 per person per year if more than 30 employees receive government subsidies to help them buy insurance.” “The coverage employers provide also must be ‘affordable’ — meaning it can’t cost a single worker more than 9.5 percent of his or her income.” The Hill (12/29, Baker)

Insurer user fee: “The Health and Human Services department is proposing a ‘user fee’ amounting to 3.5 percent of premiums for health insurers who want to offer policies in new federal exchanges coming in 2014.” According to HHS, “the fee is to cover administrative costs of the new markets, which were designed to be self-supporting.” “The proposed administrative fee in the new exchanges would be higher than the 2 percent to 3 percent overhead commonly cited for running Medicare, a disparity that critics of the law were quick to point out.” The AP (11/30)

There are many, many more regulations that have been released and many more to come. Stay tuned!