The Patient Protection and Affordable Care Act, also known as the PPACA or “Obamacare” is currently being reviewed by the Supreme Court who will issue a verdict in June which could nullify part or all of the act’s provisions. Nevertheless, California is pushing ahead with a host of measures to bring the state into compliance with health care reform.
AB1846 – CO-OPs
AB1846 establishes licensing requirements for health insurance providers who are member-run and non-profit. These Consumer Operated and Oriented Plans would offer coverage at fair rates to individuals and small groups who, in the current environment, often cannot afford to purchase health care insurance. In the federal plan, these small groups that form to negotiate better insurance deals are called “exchanges.”
AB1921 Transitional Reinsurance Program
AB1921 opens the door to reimbursing California Health Insurance agencies who take on higher-risk policy holders such as older people or people with pre-existing conditions. These subgroups represent a signicant expense for insurance agencies, and this policy, if passed, would help ease the financial burden.
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SB1431 would place new regulations around the sale of stop-loss insurance, and AB 52, which is still in committee, would allow the insurance commissioner to final say over proposed rate increases.
What PPACA Means for California Health Insurance
Under the proposed legislation, insurance companies can employ one of two strategies. The first strategy is to actively pursue insurance leads with pre-existing conditions knowing that they can get money from the state Transitional Reinsurance Program for taking on these difficult and more expensive cases.
Another strategy, if PPACA is allowed to stand in its entirety, is aggressively pursuing insurance leads who are young and healthy. These people are typically inexpensive to care for. In the past, many have chosen to go without health insurance, but the Patient Protection and Affordable Care Act mandates most Americans to either carry health insurance on themselves and their dependents by 2014 or pay a penalty. Depending on the Supreme Court’s June ruling, this is a population that is ripe for prospecting.
Until the Supreme Court hands down its decision, though, insurance companies must function without any clear directives and a lot of uncomfortable “what ifs?”