Policy Roundtable Abstracts - AcademyHealth

evisit the topic for at least a decade, maybe two or
three. Meanwhile, Baby Boomers will be able access
home care more readily, but for the real catastrophe,
nursing home care costs, they will still be waiting for an
answer. And so will state Medicaid budgets. Dr. Ng will
focus on HCBS. He observes that over the past two
decades state Medicaid programs have greatly
expanded HCBS although considerable interstate
variation in access to services remains. The PPACA has
three important provisions to expand HCBS. First, the
Community First Choice Option allows states to provide
attendant care services with enhanced federal matching
assistance. Second, HCBS can be offered as an optional
benefit instead of a waiver at a financial eligibility level of
300% of SSI. Third, the State Balancing Incentive
Payments Program provides five years of enhanced
federal matching to eligible states to increase HCBS.
Although these provisions are valuable, the law does not
set minimum standards for HCBS benefits. Moreover,
the new incentives may not be sufficient to encourage
major changes in light of ongoing state budget
difficulties. Wide variations in access to HCBS can be
expected to continue while HCBS competes with
mandated institutional care for funding. Dr. Stone will
focus on the LTC workers. She argues that the PPACA
will impact the development and sustainability of the LTC
workforce in several ways. Specific programs designed
to support and strengthen the elder care workforce
include financial incentives to encourage individuals to
pursue geriatric careers across professions, the
expansion of the Geriatric Education Centers program,
and the development of core competencies and curricula
for direct care workers. Indirectly, the PPACA will
influence the LTC workforce through provisions
designed to shift LTC from a primarily institutional to
HCBS system. Promulgation of new payment
methodologies designed to improve quality and
efficiency in Medicare and an array of demonstration and
pilot projects designed to promote person-centered care
will further impact its size and structure. Ultimately, the
type of education and training and practice patterns
required will need to be altered to successfully achieve
the goals inherent in these provisions. Dr. Phillips will
focus on the provision of nursing home care. He argues
that those portions of the PPACA most likely to have
direct effects on nursing home quality are the Nursing
Home Transparency Act and the Elder Justice Act.
Potential advantages of these programs include an
emphasis on quality assurance, performance
improvements, abuse prevention, standardization of
complaint processes, and strengthening enforcement
remedies. By contrast, it is likely that the PPACA’s
emphasis on shifting LTC services from nursing homes
to HCBS will have indirect effects on nursing home
quality. This is because successful implementation of
such a shift will depend heavily on significant institutional
restructuring; increases in human capital in the LTC
sector; and the identification of funding sources for the
provision of high quality care, both in the community and
in nursing homes.
Evaluating Short-Run Effects of PPACA on U.S.
Health Insurance Markets: Data, Measurement, and
Research Opportunities
Organizer/Moderator: Jean Abraham
Tuesday, June 14 * 11:30 a.m.–1:00 p.m.
Panelists: Richard Kronick, Ph.D., U.S. Department of
Health and Human Services; Brad Herring, Ph.D.,
Johns Hopkins University; Jeff Lemieux, Ph.D.,
America's Health Insurance Plans; Eric Nordman,
National Association of Insurance Commissioners
Roundtable Summary: A central focus of the Patient
Protection and Affordable Care Act (PPACA) of 2010 is
to improve the functioning of the individual and small
employer group markets for health insurance through
increased regulation. In the first two years following
passage of the legislation, several new regulations will
be implemented that will affect insurers, consumers, and
employers. Five key provisions include:
1) Establishing minimum medical loss ratios of 85
percent for the fully-insured large group market and
80 percent for the small group (2-100 workers) and
individual markets.
2) Having states conduct annual reviews of
“unreasonable increases in premiums” for nongrandfathered
health plans.
3) Prohibiting lifetime limits on the dollar value of
coverage for individual and group health plans.
4) Prohibiting insurers from denying children coverage
based on pre-existing medical conditions or from
including pre-existing condition exclusions for
children in policies.
5) Requiring new health plans to provide coverage
without cost-sharing for certain preventive services.
The purpose of this policy roundtable is to have a
engaging discussion among key stakeholders and
audience members relating to what is currently known
about health insurance market functioning, as well as the
types of research questions and data infrastructure that
will be needed to effectively evaluate the short-run
effects of PPACA on the individual market, the small
employer group market, and large employer group
market (fully-insured and self-insured) for health
insurance.
The roundtable discussion will be strengthened by
having a diversity of stakeholder perspectives
represented, including: U.S. Department of Health and
Human Services (DHHS): Given administrative
rulemaking responsibilities, a representative from HHS
can provide valuable insights regarding specific gaps in
knowledge that would be of high value to policymakers
for measuring and understanding the intended and
unintended consequences of these regulatory changes
on insurance market outcomes reflecting both the
supply-side (e.g., entry and exit, plan offerings, benefit
designs, etc) and the demand-side (e.g., consumer
access, affordability, choice).
National Association of Insurance
Commissioners: The NAIC is the organization of state