contacted by the Congressional Budget Office (CBO) this month and met
via conference call to discuss the equitable treatment bill, H.R. 3463.
The CBO is tasked with “scoring” or estimating the cost or savings to
the federal government of a legislative proposal and can examine impacts
to government budgets and revenues (i.e. taxes). Also, the CBO examines
the costs of any new federal mandates that legislation would impose on
state, local, or tribal governments or on the private sector.
The call was
an opportunity for CBO to ask questions and learn more about how the
Affordable Care Act’s (ACA’s) reasonable assurance provision has
impacted the off-Exchange market and possible changes from H.R. 3463.
They started with a specific question on Idaho’s interpretation of
reasonable assurance and asked whether this was a common state approach.
Thanks to information confirmed by Exchange Policy Workgroup (EPW)
volunteers before the call, we could explain Idaho’s state law
prohibiting carriers from requiring consumers to purchase coverage
additional to medical and the impact to their reasonable assurance
policy, which is an outlier and not representative of any other state.
Next, a series
of questions focused on how carriers have reacted to reasonable
assurance in the off-Exchange markets. We explained that the federal
regulation places the responsibility to determine whether the reasonable
assurance standard has been met on the carrier, who must offer
Essential Health Benefit coverage. National carriers may have worked
with their internal General Counsel to interpret the standard and
implement a national compliance plan, while single-state and regional
carriers may be more likely to rely on state interpretations.
provided education and information on the small group market and dental
benefits and provided NADP’s State of the Market in a follow-up email.
CBO’s insightful questions and the bipartisan support at this month’s hearing
are good signs that Congressional Committee staff intend to move the
bill forward. CBO rarely reaches out to stakeholders for additional
information and last week’s call illustrates that NADP’s data-driven
efforts and transparency are viewed positively by government officials.