Tag Archives: Mike Sturm

CORAL: A roadmap for ACA

Milliman’s Cost Relativity Analysis Model (CORAL) tool helps users estimate relative values of different health benefit plans. CORAL allows users to see how changing variables such as copays, deductibles, and coinsurance will affect per-member-per-month (PMPM) costs.

In this short film, Milliman consultants Michael Sturm, Barbara Collier, and Emily Jayne discuss how CORAL makes benefit calculations easy and helps businesses gauge the effects of healthcare reform.

To learn more about CORAL, click here.

2014 federal insurance exchange: Evaluation of insurer participation and consumer choice

The Center for Consumer Information and Insurance Oversight (CCIIO) has released insurer plan information for the federally facilitated exchanges in 34 states for the individual exchange market and 32 states for the Small Business Health Options Program (SHOP) exchange market. This information covers the state and federal exchanges since they opened October 1, 2013.

This newly released plan information gives consumers and the health insurance industry the first opportunity to view the landscape of the new exchange market and provides key insights into the makeup of the insurance markets.

Premium and plan information for each plan offered in the federal exchange is provided by state, exchange rating area, and county. Therefore, we are now able to see the large variation between the number of participating insurers, new entrants, and plan designs available on the federally facilitated exchanges, which vary greatly not only between states, but within states at the county level.

In some states, market share in the individual and small group markers may be minimally impacted by the exchange marketplace. However, in states that have insurers with significant current market share declining to participate in the exchanges, or in states with new Medicaid or Consumer Operated and Oriented Plan Program (CO-OP) insurers entering the market, market share may change significantly in a short period of time.

This Healthcare Reform Briefing Paper by Paul Houchens, Mike Sturm, and Jason Clarkson provides perspective on insurer participation and consumer choices in the 34 states where CCIIO data is available.

Decision day

Today’s elections will have major implications for healthcare reform. Back in February, Mike Sturm and John Meerschaert provided foresight on how healthcare reform could be affected by the U.S. Supreme Court’s ruling on the Patient Protection and Affordable Care Act (PPACA) and the general election. As we now know the Supreme Court preserved the constitutionality of PPACA, except that states can opt out of Medicaid expansion.

Here is an excerpt from Sturm and Meerschaert’s article “Healthcare reform in 2012: Blind curves ahead” discussing the effects of potential election results:

The November 6 general election may prove to be a bigger factor than the Supreme Court decision, because the potential result could be a complete repeal of the PPACA… here are three scenarios:

President Obama is re-elected. If the president is re-elected, a Republican-controlled Congress may try to repeal the healthcare reform legislation, but President Obama will veto the repeal. Unless Congress overrides the veto—which is doubtful because it requires a two-thirds majority in both houses—the program will move forward; the exchanges will be created, and all other provisions of the PPACA (minus any that are ruled unconstitutional) will eventually become operational. If the Democrats control either house, no repeal bill is likely to pass.

There is also some speculation that President Obama might back off of some PPACA provisions because of their political unpopularity, but this remains, at most, a remote possibility.

A Republican president is elected, but the Democrats control at least one house of Congress. No attempt at repealing the 2010 legislation is likely to pass, and PPACA will remain the law of the land. However, the real power of implementation rests with the executive branch, and it is probable that the new president’s appointees in the Department of Health and Human Services and the Centers for Medicare and Medicaid Services will delay the major provisions of the law. In particular, the exchanges will probably not be implemented by the currently scheduled date of January 1, 2014.

The Republicans capture the presidency and both houses of Congress. In this scenario, it is almost certain that the 2010 legislation will be significantly modified, if not repealed. States that have already taken steps toward setting up exchanges may or may not carry them forward in the absence of federal subsidies should the Republicans repeal the subsidies.

If polls are to be believed, the third option is a real long shot. Perhaps we will know which direction healthcare reform is headed by tomorrow morning.

CO-OPs and community health centers: Kindred spirits

Consumer operated and oriented plans (CO-OPs) share many similar values with the community health centers (CHCs) that are supported by the Health Resources and Services Administration (HRSA). Both are nonprofit with consumer-majority governing boards, and the population that currently obtains care through CHCs will likely account for many of the members that CO-OPs enroll. This edition of Milliman’s CO-OP Point of View newsletter discusses how CO-OPs and CHCs are currently in alignment and may be poised for mutual success. Click here to view the newsletter.

States, PPACA, and the November general election

In addition to the Supreme Court challenge to the Patient Protection and Affordable Care Act (PPACA), the upcoming presidential and state elections are likely to have an effect on the implementation of the law. Milliman consultants John Meerschaert and Michael Sturm projected some of the possible outcomes in a recent feature story. As they point out,

The November 6 general election may prove to be a bigger factor than the Supreme Court decision, because the potential result could be a complete repeal of the PPACA.

Assuming the law is not struck down in its entirety by the Supreme Court, the authors predict that the elections are likely to result in one of the following outcomes for the PPACA:

  • President Obama is reelected. Repeal legislation will be vetoed, the PPACA will move forward in whatever form is left by the Supreme Court, and exchanges will go forward.
  • A Republican president is elected, but the Democrats control at least one house of Congress. No attempt at repealing the 2010 legislation is likely to pass, and the PPACA will remain the law of the land. Major provisions of the law may be delayed, especially exchanges.
  • The Republicans capture the presidency and both houses of Congress. The PPACA will be significantly modified, if not repealed. Without federal subsidies, states would have less incentive to create exchanges, although some states might keep moving forward.

One of the most interesting questions is this: if they win, what would Republicans replace the PPACA with, if anything? The National Journal offered some perspective in a recent discussion, and Uwe Reinhardt today offered his take on the Economix New York Times blog.

States, PPACA, and the Supreme Court

The uncertain fate of the Patient Protection and Affordable Care Act (PPACA), which is due to a Supreme Court challenge and the upcoming elections, is making 2012 an interesting year for states. While some healthcare stakeholders may be taking a wait-and-see approach, the clock continues to tick toward PPACA deadlines—as demonstrated with today’s release of exchange regulations.

A report recently released by the White House says that 28 states are making significant progress toward establishing exchanges. The National Conference of State Legislators shows on its updated web page that 12 states have passed legislation to establish exchanges. In all, according to The Commonwealth Fund, 28 states have received federal grants for the establishment of exchanges. On the other hand, many are waiting for more information, an action HHS Secretary Sebelius called “pretty appropriate” according to City & State, a newspaper that covers New York State politics.

So what will happen if the law is struck down in whole or in part by the Supreme Court? Two Milliman consultants, Michael Sturm and John Meerschaert, examined the issues in detail in a recent feature story.  They see several possible outcomes:

  • The law is ruled wholly constitutional by the Supreme Court. While the authors see this as unlikely, it is possible. Even so, however, deadlines for implementation of exchanges would likely be delayed. States would not be out the dark yet, as the November elections could still have a significant impact on which provisions are implemented.
  • Part or all of Title I is ruled unconstitutional by the Supreme Court. The most vulnerable part of the law is the trifecta of individual mandate, guaranteed issue, and prohibition of the ability to consider preexisting conditions. If these are eliminated, exchanges will most likely be used by healthier, less wealthy segments of the population as they will receive a subsidy. For more on the strength of the individual mandate, see this Milliman Research Report by Paul Houchens.
  • Part or all of Title II is ruled unconstitutional. Due to precedent, this is unlikely, but if it happens, states will probably continue operating their current programs and the rise of managed care in Medicaid will continue.
  • The entire law is struck down. This is also seen as unlikely. Even if this occurs, some states may go ahead with the establishment of exchanges.
Assuming the Supreme Court decides before November, and assuming that it leaves some portion of the law intact, the PPACA won’t be a settled issue until after the general election. In a subsequent post, we’ll look at implications of the November 2012 general election for the PPACA at the state level.