Kristin Leighty, Government Affairs Coordinator, NAHU Legislative Update September 14, 2011 Kristin Leighty, Government Affairs Coordinator, NAHU

NAHU Government Affairs team Laurel Call, Sr. Vice President and Counsel – Regions 6 & 8 lcall@nahu.org 703.276.3801 Jessica Waltman, Sr. VP of Government Affairs – Region 2 jwaltman@nahu.org 703.276.3817 Pam Mitroff, Director of State Affairs – Illinois, West Virginia, Regions 4 & 7 pmitroff@nahu.org 703.276.3839 Brooke Bell, Director of State Affairs – Region 1, 3 & 5 bbell@nahu.org 703.276.3818 Kristin Leighty, Government Affairs Coordinator kleighty@nahu.org 703.276.3803

Exchange Developments New Proposed Rules Released will Impact Exchanges August 15th the administration released three proposed rules: Exchange eligibility and employer standards (HHS) Medicaid eligibility increase and the proposed enrollment system (HHS) Guidance on premium subsidies for coverage accessed through the exchange (IRS) NAHU Staff and Exchange Working Group continues to analyze all recent regulations Questions remain surrounding the foundation of a federal fall-back exchange HHS launches Exchange Listening Tour Kick-off regional exchange listening session took place on Aug. 23 in Portland, OR Additional listening sessions scheduled for Atlanta, Chicago, Denver, New York and Sacramento over the coming weeks State Exchange Activity Remains Busy Scoreboard: Signed-13 (CA, CO, CT, HI, IL, MD, ND, NV, OR, VA, VT, WA, WV On Hold-9 (DC, ME, MN, NE, NC, NH, NY, PA, TX) Dead/Vetoed-11 (AK, AZ, AR, IN, MO, MT, NE, NM, OK, RI, SC) Work Arounds-8 (AL, GA, IN, IA, KS, MS, OH, WI)

MLR and H.R. 1206 Grassroots push over the August Recess Build on relationships made with any of the Legislators you met with Keep up the grassroots pressure with Operation Shout! advocacy messages Cosponsor total at 120! Congress Back in Session House Energy and Commerce Committee to hold another hearing on PPACA issues Janet Trautwein will testify on behalf of NAHU on MLR Increasing pressure on the Department of Health and Human Services (HHS) to achieve a regulatory solution to MLR GAO Report on MLR Impact Confirms that biggest impact from the PPACA MLR requirement is on agents and brokers

Status of MLR State Waivers HHS Denies Delaware’s Application HHS reasons that DE insurance carriers in individual market can remain profitable even after issuing rebates NC and OK submits application for a waiver NC asks for 72% adjustment in 2011, 74% in 2012 and 76% in 2013 OK asks for 65% this year, 70% in 2012 and 75% in 2013 OK asks for a waiver in the individual and small group markets Scoreboard: Approved: ME, NH, KY, NV, IA Denied: ND, Guam (deemed unnecessary), DE Pending Applications: FL, GA, IN, KS, LA, TX, MI, OK, NC

Summary of Coverage Documents Issued by HHS HHS releases proposed regulation on August 17 for the uniform EOBs and standardized ins terms required by PPACA Insurers are required to provide this info to consumers 60 days prior to enrolling in coverage or 30 days prior to reissuance or renewal beginning on March 23, 2012. Summary template was drafted from text developed by an NAIC panel Janet Trautwein served on this panel Stakeholder concerns remain Will such requirements create an onerous burden on insurers and drive up administrative costs?

HHS Exempts HRAs from Annual Limits Requirement HHS Announces HRAs do not have to comply with PPACA’s annual limits requirement HHS has already issued 41 waivers to the annual limits requirement for HRAs. The announcement addresses the lingering question of whether the requirement should apply to stand-alone HRAs in effect prior to Sept. 23, 2010 and will stop the need HRAs to apply for such waivers. In addition, HHS released approval of 106 new annual limit waiver applications made by employer-sponsored plans These waivers are valid until January 1, 2014 HHS set a deadline of Sept. 22, 2011 for such plans to apply for a waiver including plans with current waivers seeking extensions

11th Circuit and 4th Circuit Court Action on PPACA Challenge 11th Circuit Court of Appeals ruled August 12 that the individual mandate requirement is unconstitutional Ruling increases the odds that the Supreme Court will hear this case Obama Administration’s next step remains uncertain 4th Circuit Court rules on two challenges to PPACA On September 8th the 4th Circuit Court of Appeals issued two rulings rejecting the cases brought by the Commonwealth of Virginia and Liberty University The Court ruled that the Anti-Injunction Act prevents the judicial branch from ruling on a tax (i.e. PPACA’s individual mandate) before its implementation. Poses new questions for any additional challenges if the Supreme Court takes this same approach.

Other News… Call for Volunteers for NAHU Professional Exchange Certification Committee HHS Call for feedback about the Small Business Tax Credit Watch Janet testify in front of the Energy and Commerce Health Subcommittee tomorrow morning!

Next Legislative Update: THANK YOU!! Next Legislative Update: October 12 at 1:00PM EST