As predicted, the most informative developments in health reform last week took place at the SPBA Spring Meeting. Since only SPBA member TPAs & Stop-Loss Partners are allowed to attend those meetings, this is provided as a quick summary to the broader benefits community. As always, SPBA members will get detailed specific technical analysis as soon as what we think we are reading is confirmed with the reg writers in order to assure that what we report is accurate.
W-2:
Within minutes of the W-2 guidance being issued, the person in charge called to say that that meant he was now free to come to the meeting and give a detailed report and sought further input & brainstorming as thanks for the leading role SPBA has played in providing real-world advice on the project. So, the agenda was jiggled to add the breaking news. The report is that they “get it” that there are dozens of ways to come up with (different) numbers. We in the plan & employer (and worker) world are trying to figure out what long term scheme is underway. The reg writer was candid that, at this point, they just need a good faith effort number, so we are not about to get some draconian process.
SELF-FUNDING STUDY:
Within hours of the Self-Funding study being issued, the leader of the project was explaining the thinking inside and behind the effort. It was gratifying that the extensive ongoing detailed information, history & inter-relationships that SPBA had been providing to the various entities involved in the study had been absorbed. We knew that the intent of the study was not a “gotcha” or to smear the self-funding industry, and that was evident in the study. This study of self-funding will be on-going, and the leader immediately started picking the brains of the SPBA audience to continue to fine-tune their understanding of how self-funding works in the real world. Note: the Self-Funding study is mainly for Congress, so if there are entities out to harm self-funding, the Congressional route is where the attacks will come.
ESSENTIAL BENEFITS
The entire leadership team deciding Minimum Essential Benefits made themselves available, answered questions, and brainstormed with the audience. The good news is that they “get” the message SPBA and our members have been hammering home not to have a package that is so huge, so comprehensive and so expensive & inflexible that it will be unaffordable for both the private sector and the government plans….and will stifle the flexibility of plan design which has been the main driver of the growth of self-funding. They “get it” so well that they pleaded with the audience to pour in their insights within the next week (in their hands before April 14th) in order to offset the flood of special interests pushing for every conceivable specialty service. SPBA and its members are jumping on that instantly.
TRIUMVIRATE:
The multi-agency triumvirate that is writing the regs on most of the many nitty-gritty issues of PPACA gave multiple sessions with in-depth candid reports, brainstorming and seeking input from the audience for items raised for which they did not have answers. There were several candid “we don’t know” answers, but that is actually good news. Each year, about a dozen regs or requirements are changed, eased or backed-off because of the face-to-face candid off-the-record brainstorming format between SPBA members and the people writing those requirements. “I don’t know” and request for explanation & input from the reg writers usually ends up with those items turning out the way we want.
CLASS:
The two top people gave a candid explanation of the program and their progress so far (and laughed that SPBA had started the interaction with them so promptly that CLASS had one person sitting on a chair in an empty office at the time). They were also candid that, yes, CLASS might be repealed/dropped…and/or perhaps replaced with some different version.
EXTERNAL/INTERNAL REVIEWS, COURT PROSPECTS, ETC ETC:
Again, there were several sessions with the latest technical details and brainstorming. A big-picture report & forecast on the future of PPACA as well as a review of the court cases’ timing & prospects was also provided.
SCOTUS: The “Supremes” are extremely antsy about ruling on such a large, emotional/political and specifically-passed law, so they lean towards waiting for the whole process of about 24 cases and then appeals before even taking the case, probably in 2012, with, possibly a decision later that year. (You & I see right now as the time for decisions, & guidance, but on most things, government sees 2014 as the effective date.) Also, they could decide many ways....from only a narrow ruling on the individual mandate to the whole law blocked, to many variations inbetween. On April 15, they will consider whether to take up the case early, and will report a few days later. However, the take-home message of this report was that prospects for SCOTUS (Supreme Court) to wipe away PPACA are not high, and even if it did, the public is quickly getting addicted to many of the benefits of PPACA, such as adult children, no limits, no pre-ex, etc., so “replacement” would be no piece of cake no matter who is in office,...and keeping in mind that some of the most burdensome mandates & proposals on employee benefits have come from Republican Administrations & Congresses.
STOP-LOSS GOOD NEWS:
Leading up to the SPBA Spring Meeting, SPBA’s Board plus leaders of the Stop-Loss industry had a very candid brainstorming Summit. The intent was to share views, and to try to spot and avoid problems that might arise in the TPA/Stop-Loss business relationship because of PPACA. Candor was plentiful, and it was gratifying & enlightening to discover that both sides share many of the same views & concerns. Both sides are concerned that PPACA open-ended risk + continuing runaway medical inflation creates a squeeze-play on plans, Stop-Loss, and employers. So “avoiding the 60 Minutes (named after the investigative TV show) Moment is a mutual goal. There was also mutual concern that the urge to grab the cheapest-sounding deal to often leads to problem later. The Summit and a follow-up session and report at the general meeting are only the first step are only the first step, but it is very promising that both sides are approaching this with great professionalism and of the same mindset and feel we are in this together.
GOOD NEWS:
I started in employee benefits laws & regs when I was involved as ERISA legislation was taking form in 1974. I must say that the reg-writing approach & attitude for PPACA is the most open & cooperative that I have ever seen in all the intervening years….not only from the regulatory agencies (who are just doing their job of interpreting what they are handed), but even from the political-appointee officials. This makes this process more productive. We have not gotten the “our way or the highway” attitude of Administrations of both parties in the past. I’m not cheerleading, I’m just giving credit where credit is due, and letting you know that the PPACA reg process is not in the hands of a bunch of ideologue crazies. This new attitude works well with SPBA’s under-the-radar non-political non-partisan real-world style. We offer reg-writers and legislation-shapers access to the unmatched expertise of unbiased hands-on experts in every size & format of employment and type of health plans. It works.
REALITY CHECK:
OK, before you start grilling an SPBA Spring Meeting attendee for every detail of every aspect of PPACA, let me report a factoid researched by one of our members. There are 1,430 items in PPACA that will need regulations. Only about 20 have been addressed yet, and even those for which guidance or regs have been issued are still in the brainstorming stage. So, absolute guidance and hard facts are still a long way away…..10 years or more in some cases.
So, that’s where the productive action was last week, and this is was to give you that insider insight.
Fred
SPBA is the national association of Third Party Administration (TPA) firms who administer over half the lives of US workers in non-federal health benefit plans. This provides not only the perspective of size, but also, uniquely, every size & format of employment and every form of plan funding format. SPBA also has the leading Stop-Loss sources as Service Partners. SPBA’s efforts are targeted to enhancing the knowledge & impact of those members, so there are no associate memberships, or commercial opportunities such as exhibits, and SPBA meetings are only open to SPBA members. For more information, visit the SPBA public website at www.SPBAtpa.org. Be sure to click on the issues and other items in the black header.
Personal candid comments from SP{BA Active Past President Fred Hunt