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

2. NAHU Government Affairs team
Laurel Call, Sr. Vice President and Counsel – Regions 6 & 8
Jessica Waltman, Sr. VP of Government Affairs – Region 2
Pam Mitroff, Director of State Affairs – Illinois, West Virginia, Regions 4 & 7
Brooke Bell, Director of State Affairs – Region 1, 3 & 5
Kristin Leighty, Government Affairs Coordinator

3. 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)

4. 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

5. 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

6. 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?

7. 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

8. 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.

9. 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!

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