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Bloomberg BNA: CMS Needs to Provide Congress SHOP Data On Enrollments, Rep. Collins Says at Hearing

Bloomberg BNA: CMS Needs to Provide Congress SHOP Data On Enrollments, Rep. Collins Says at Hearing
By Sean Forbes
 September 18, 2014


Republican members of a subcommittee of the House Committee on Small Business insisted at a hearing on Affordable Care Act small business exchanges that the administration must provide hard data to Congress in order to have an unbiased discussion about the effectiveness of the exchanges.

Rep. Chris Collins (R-N.Y.), chairman of the Subcommittee on Health and Technology, said that the Small Business Committee sent letters in January and June to the Department of Health and Human Services and the Centers for Medicare and Medicaid Services requesting enrollment figures for the Small Business Health Options Program (SHOP), but the HHS hasn't supplied any data yet.

Collins several times asked Mayra E. Alvarez, director of the state exchange group in the CMS Center for Consumer Information and Insurance Oversight, about whether the information is available and when the Congress can expect to receive the data. Alvarez didn't have a precise date, but promised that, after the CMS collected the data from the state SHOPs, it would give the information to Congress and the public “as soon as it's available.”

“As soon as it's available,” Collins repeated.

The CMS data will take the bias out of the debate over the SHOPs, but until then people “are just talking past each other,” Collins said.

After the Sept. 18 hearing, Collins told Bloomberg BNA that, “I'm not holding my breath” for the data to arrive soon.

The 90-minute hearing was titled Update on the Small Business Health Options Program: Is It Working for Small Businesses?

Fixing the SHOPs

All the members of the subcommittee, Republicans and Democrats, agreed that the SHOPs aren't perfect and are in need of repair, but differed as to their effectiveness.

Ranking Member Janice Hahn (D-Calif.) said that Medicare, enacted in 1965, also wasn't perfect and is still being improved today, “but that doesn't mean it was bad.” The same can be said for the ACA, she said.

Other witnesses differed on how to fix the SHOPs.

Roger Stark, health care policy analyst for the Seattle-based Washington Policy Center, an independent, nonprofit think tank, said that insurance rates and benefit levels should be set by the insurance market and not by government regulations, and that the state marketplaces should be able to offer an array of insurance plans without having to include the essential health benefits required under the ACA in order to make the market more competitive.

Alvarez disputed that claim, and said that the “biggest problem” with Stark's solution is that it would lead to adverse selection, which would in turn lead to higher costs for employers and plan participants.

Jon Gabel, senior fellow at the independent research organization NORC at the University of Chicago, agreed with Alvarez and said that plans in the exchanges must at least provide a minimum benefits package. Prior to the ACA, many offered plans had very low actuarial value, he said.

Rather than setting limits on copays, coinsurance and deductibles, the ACA established four actuarial value levels of coverage on plans—bronze, silver, gold and platinum—which represent the share of health-care expenses the plan covers for a typical group of enrollees. Most plans prior to the ACA provided less than 80 percent of actuarial value, the level of a gold plan, Gabel said.

Temporary Subsidies

The ACA allows employers with fewer than 25 full-time equivalent employees to apply for a temporary subsidy, called the Small Business Health Care Tax Credit, under which they will only have to pay up to half of the premium for their full-time employees.

Rep. Blaine Luetkemeyer (R-Mo.) asked Alvarez for the basis upon which the CMS made its decisions on whether an employer could get the temporary subsidy.

Alvarez said the decisions are based on flexibility and responsiveness to the needs of the market.

“But what's the basis?” Luetkemeyer asked.

“I can definitely get back to you with that information,” Alvarez said.