LEG REG REVIEW Health Edition
2018, 25th Issue *** August 6, 2018

LEG REG REVIEW is a periodic newsletter produced by PHILLIPS ASSOCIATES, a professional lobbying and consultant firm located near the State Capitol. It contains news on Pennsylvania legislation and regulations impacting the Insurance and Business Communities. Subscriptions are $100 per year and further information may be obtained by contacting PHILLIPS ASSOCIATES at 717/728-1217 FAX 717/232-7005 or e-mail at xenobun@aol.com.

PA INSURANCE COMMISSIONER WARNS AGENTS re SHORT-TERM PLANS
On August 1, PA Insurance Commissioner Jessica Altman issued a warning to insurance agents and brokers not to engage in marketing short-term medical plans as providing comparable coverage to Affordable Care Act full coverage plans. “I’m also extremely concerned that some insurance agents or insurer websites may try to market short-term policies as comparable to ACA plans. In the past two years, the Insurance Department revoked eight licenses because of deceptive marketing of these plans, so I urge consumers to be very careful when examining short-term plans and to contact the Insurance Department if they were led to believe that their short-term policy met ACA comprehensive coverage requirements” she said. This was a reaction to the Federal Government’s final approval of changes in short-term health insurance plans which the Obama Administration had limited to three months. The Trump Administration changes extend the full life of these policies to three years, renewable yearly. Commissioner Altman also said that these short-term plans do not offer minimum coverage requirements and as such, should not be presented as an alternative to major medical coverage since “they are not required to cover essential health benefits, prescription drugs or (first-dollar) preventive services.”

Following is a link to the short-term policy rule: https://www.cms.gov/CCIIO/Resources/Files/Downloads/dwnlds/CMS-9924-F-STLDI-Final-Rule.pdf

DEPARTMENT STRESES STATE REGULATORY re ASSOCIATION HEALTH PLANS
On August 2, PA Insurance Commissioner Altman sent letters to HHS Secretary Azar and U.S. Department of Labor Secretary Acosta addressing concerns PA has about President Trump’s rule on Association Health plans (AHPs) which takes effect September 1, 2018. The core concern is that an association may provide for health insurance for its members ONLY if it meets PA legal requirements of organizing for purposes other than insurance and has been in existence for at least two years. In addition, AHPs must be fully insured using an insurance entity which has a certificate of authority to do business in the Commonwealth. Her letter also made the following points:

A sole proprietor is part of the individual insurance market and is not an employer for purposes of health insurance coverage.
An AHP is actually a Multiple Employer Welfare Arrangement (MEWA).
Policy forms, rates, solvency and insurance broker licensing requirements for both in-state and out of state insurance producers are regulated by state law.

REGULATORY AGENDA RELEASED
Each year, the Governor’s Office lists those regulations being considered by each government agency. The full list is published in the PA Bulletin issue for August 4.
The Insurance Department posted four.

Medicare Supplement NAIC Regulation Update -- #11-256
Privacy Opt-out Notices for Financial Information (NAIC Model) -- #11-257
Health Insurance Company Reserves (NAIC Model) – no regulation number yet; projected for spring 2019
Producer Licensing Regulatory Updates – no regulation number yet: projected for spring 2019

The Regulatory Coordinator for the PA Insurance Department is Bridget E. Burke 717-787-2567.
CMS ISSUES AGENT/BROKER EXCHANGE GUIDELINES
The Centers for Medicare Medicaid Services issued several guidance pieces for those insurance agents and brokers seeking to enroll individuals into the exchanges.
PY2019 Registration and Training for New Agents and Brokers

CBT: PY2019 Registration and Training for Returning Agents and Brokers - Alternate Text File: PY2019 Registration and Training for Returning Agents and Brokers

PY2019 Registration and Training for Returning Agents and Brokers

CBT: PY2019 Registration and Training for New Agents and Brokers

NAHU ASKS FOR CALIFORNIA FIRE RELIEF
The National Association of Health Underwriters (NAHU) is asking its members to donate gift cards (no cash) that can be used for fuel, food, and lodging. These would be given to NAHU members in California who are affected by the massive fires raging through the state. Details: Kimi Shigetani kimi@cahu.org

SUMMER SINGLE PAYER ISSUE HEATS UP
Two new studies on the proposed Medicare for All plan pushed by Senator Bernie Sanders (VT) have added to the political debate in 2018. Although such legislation would not get through Congress this year, many Democrats are making it a standard of their congressional campaigns in this mid-term election.

Released July 30 was a report from the libertarian Mercatus Center of George Mason University which said that Medicare for All would add $32.6 trillion to the Federal Budgets from 2022-2031. This would be equal to 10.7 percent of Gross Domestic Product in 2022. The study did not project consequences on medical care except to suggest that Medicare for All would mean a marked increase in demands for health care, coupled with a 40-percent decrease in payments to health care providers.

https://www.mercatus.org/publications/federal-fiscal-policy/costs-national-single-payer-healthcare-system

New York’s Assembly passed a New York version of Medicare for All on June 18 (bill number A4738). It faces an uncertain future in the Senate where Democrats only have a one-vote majority. This is the fourth time the Assembly passed single payer. A report by RAND Corporation on August 1, 2018 said that the New York plan would reduce health care spending by two-percent. University of Massachusetts professor Gerald Friedman who has issued numbers of similar studies for other states like Maryland (2013) concluded in June 2018 that the New York bill would save more than $70 billion in 2019 and would generate 200,000 more jobs. An unusual side note is that advocates say that New Yorkers would see property tax relief since part of those taxes helps subsidize Medicaid.
On September 5, the Greater Philadelphia Association of Health Underwriters (GPAHU) will hold a program in Malvern, “Single Payer: A Look at Other Countries and Those Within the United States,” presented by NAHU’s CEO Janet Troutwein.
Following are several resources for those seeking a list of research done on Single Payer. The first two, HEALTHCARE-NOW! And Physicians for a National Health Program are for Single Payer.

https://www.healthcare-now.org/single-payer-studies/listing-of-single-payer-studies/
http://www.pnhp.org/facts/single-payer-resources

Interestingly, pro-Single Payer Physicians for a National Health Program published a list of 20 think tanks opposed to Single Payer. Included are the Heritage Foundation www.heritage.org and the Galen Institute https://galen.org/ . A link to the full listing of 20 follows: http://www.pnhp.org/news/2010/july/right-wing-think-tanks-and-health-policy