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  • Rule Finalizes Consumer Protections Under ACA

    The Department of Health and Human Services (HHS) issued a final rule last week implementing several consumer protections under the Affordable Care Act (ACA) to prevent insurance companies from discriminating against people with preexisting conditions and protect consumers from insurance company abuses.

    Under these reforms, all individuals and employers have the right to purchase health insurance coverage regardless of health status. In addition, insurers are prevented from charging discriminatory rates to individuals and small employers based on factors such as health status or gender, and young adults have additional affordable coverage options under catastrophic plans.

    These 5 key provisions are applicable to nongrandfathered health plans:

    • Guaranteed Availability—Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.
    • Fair Health Insurance Premiums—Health insurance companies offering coverage to individuals and small employers will be allowed to vary premiums based only on age, tobacco use, family size, and geography.  Basing premiums on other factors will be illegal. The factors that are no longer permitted in 2014 include health status, past insurance claims, gender, occupation, how long an individual has held a policy, or size of the small employer.
    • Guaranteed Renewability—Health insurance companies will no longer be permitted to refuse to renew coverage because an individual or an employee has become sick. Consumers may renew coverage at their option.
    • Single Risk Pool—Health insurance companies will no longer be able to charge higher premiums to higher-cost enrollees by moving them into separate risk pools. Insurers are required to maintain a single statewide risk pool for the individual market and single statewide risk pool for the small group market.
    • Catastrophic Plans—Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market. Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventive services without cost sharing.

    In preparation for the health insurance marketplaces and to streamline data collection for insurers and states, the final rule amends certain provisions of the rate review program. HHS has increased the transparency by directing insurance companies in every state to report on all rate increase requests. A new report has found that the law's transparency provisions have already resulted in a decline in double-digit premium increases filed, from 75% in 2010 to, according to preliminary data, 14% in 2013.

    IOM Roundtable to Focus Attention on Nonmedical Factors That Influence Health

    Building on previous studies that show many factors beyond medical care affect people's health, the Institute of Medicine (IOM) recently established the Roundtable on Population Health Improvement to explore the interactions of these influences. The new roundtable will provide opportunities for experts on education, urban planning, medicine, public health, social sciences, and other fields to interact and share their knowledge and perspectives with the goal of catalyzing joint action. 

    As a recent study by the National Research Council and IOM documented, Americans experience worse health and shorter lives than people in other rich, industrialized nations despite spending more on medical care than any other nation. Several IOM studies have described the effects of social and environmental factors that can lead to poor health even when people have access to good health care. The nation's lagging health burdens businesses, communities, and families, these reports note.

    The roundtable will engage roundtable members and outside experts, practitioners, and stakeholders on 3 core issues:

    1. supporting fruitful interaction between primary care and public health
    2. strengthening governmental public health
    3. exploring community action in transforming the conditions that influence the public's health

    IOM hosts more than a dozen roundtables and forums, providing a neutral setting for diverse groups of individuals to discuss issues of mutual interest and concern and gain fresh insights and new understanding. A list of individuals who serve on the roundtable can be found on IOM's website

    USPSTF Releases Comprehensive Guide of Preventive Services

    The US Preventive Services Task Force (USPSTF) recently released its updated 2012 Guide to Clinical Preventive Services—an authoritative source that can help primary care clinicians and patients decide together what preventive services are right for a patient's needs. This edition of the guide includes the USPSTF’s evidence-based recommendations on clinical preventive services from 2002 through March 2012, topics in development, and at-a-glance clinical summary tables.

    Go to USPSTF's A-Z Topic Guide to access recommendation statements on interventions to prevent low back pain, falls in older adults, and osteoporosis. USPSTF also makes recommendations on screening for and management of obesity in adults and children.

    The 2012 guide can be found on the Agency for Healthcare Research and Quality's website.