Sources

1. Kaiser Family Foundation, “Kaiser Health Tracking Poll,” February 2011.
2. Lockton, “May 2011 Employer Health Reform Survey,” June 2011.
3. Lockton, “May 2011 Employer Health Reform Survey,” June 2011. Totals do not add to 100 because employers answered all that applied.
4. National Business Group on Health, “Survey of Large Employers Addresses Projected Costs for 2012, ACA Changes,” June 2011.
5. National Business Group on Health, “Survey of Large Employers Addresses Projected Costs for 2012, ACA Changes,” June 2011.
6. The Commonwealth Fund and Princeton Survey Research Associates International, “The Commonwealth Biennial Health Insurance Survey of 2010,” survey of 3,033 adults from July 2010 to November 2010, published March 2011.
7. National Business Group on Health, “Survey of Large Employers Addresses Projected Costs for 2012, ACA Changes,” June 2011.
8. Lockton, “May 2011 Employer Health Reform Survey,” June 2011.
9. National Business Group on Health, “Survey of Large Employers Addresses Projected Costs for 2012, ACA Changes,” June 2011.

1. National Business Group on Health, “Survey of Large Employers Addresses Projected Costs for 2012, ACA Changes,” June 2011.
2. National Business Group on Health, “Survey of Large Employers Addresses Projected Costs for 2012, ACA Changes,” June 2011.
3. The Commonwealth Fund and Princeton Survey Research Associates International, “The Commonwealth Biennial Health Insurance Survey of 2010,” survey of 3,033 adults from July 2010 to November 2010, published March 2011.
4. The Commonwealth Fund and Princeton Survey Research Associates International, “The Commonwealth Biennial Health Insurance Survey of 2010,” survey of 3,033 adults from July 2010 to November 2010, published March 2011.
5. Lockton, “May 2011 Employer Health Reform Survey,” June 2011.
6. National Bureau of Economic Research Working Paper 17072, “Financially Fragile Households: Evidence and Implications,” Annamarie Lusardi, Daniel J. Schneider and Peter Tufano, May 2011.
7. The Commonwealth Fund and Princeton Survey Research Associates International, “The Commonwealth Biennial Health Insurance Survey of 2010,” survey of 3,033 adults from July 2010 to November 2010, published March 2011.
8. CareerBuilder.com, “More Than One-Third of Workers Will Put Their Tax Refund into Savings, Finds New CareerBuilder Survey,” April 12, 2011.
9. Charles River Associates, “Financial Security for Working Americans: An Economic Analysis of Insurance Products in Workplace Benefits Programs,” August 2011.

• CLASS Act not viable
  1. Memorandum on the CLASS Act program from Kathy Greenlee, CLASS Administrator, to Kathleen Sebelius, Secretary of Health and Human Services, October 14, 2011.
  2. CareerBuilder.com, “More Than Half of Workers Will Use Their Tax Return to Pay Off Bills, Finds New CareerBuilder Survey: Nearly Eight-in-Ten Workers Report They Live Paycheck to Paycheck,” April 7, 2010.
  3. American Association for Long Term Care Insurance, “The 2010 Sourcebook for LTCI Information,” September 2010.
• Final MLR rules count broker fees as overhead
  1. Government Accountability Office, “Private Health Insurance: Early Experiences Implementing New Medical Loss Ratio Requirement,” Aug. 29, 2011.
• Employee communication rules delayed
  1. Kaiser Family Foundation, Monthly health tracking poll, November 2011.
• High-risk pool funds nearly exhausted
  1. The Washington Post, “The high risk of high-risk pools,” by Sarah Kliff, January 12, 2012.
  2. Kaiser health News, “Feds Bolster High Risk Insurance Funds in Two States,” by Phil Galewitz, December 22, 2011.
  3. Kaiser health News, “Feds Bolster High Risk Insurance Funds in Two States,” by Phil Galewitz, December 22, 2011.
  4. The Denver Post , “Colorado high-risk health insurance pool runs up claims twice the U.S. average,” by Michael Booth, January 16, 2012.
  5. 5. Congressional Budget Office, letter to Honorable Michael B. Enzi and the Committee on Health, Education, Labor and Pensions,” June 21, 2010. Available at: http://www.cbo.gov/ftpdocs/115xx/doc11572/06-21-High-Risk_Insurance_Pools.pdf
• MLR rebates to top $1 billion
  1. Kaiser Family Foundation, “$1.3 billion in MLR health insurance rebates expected,” May 7, 2012. Note: Kaiser's analysis does not include the state of California, where many plans are regulated by the state Department of Managed Health Care and the data is not yet available. The Kaiser Family Foundation data for the insurance rebates are based on estimates provided by insurers in filings to the National Association of Insurance Commissioners in the 2011 Supplemental Health Care Exhibit. The source of the data was the Health Coverage Portal TM, a market database maintained by Mark Farrah Associates, which includes information from the NAIC. Actual rebates will be based on reports insurers submit to the federal government later this year.
  2. Kaiser Family Foundation, “$1.3 billion in MLR health insurance rebates expected,” May 7, 2012. Note: Kaiser's analysis does not include the state of California, where many plans are regulated by the state Department of Managed Health Care and the data is not yet available. The Kaiser Family Foundation data for the insurance rebates are based on estimates provided by insurers in filings to the National Association of Insurance Commissioners in the 2011 Supplemental Health Care Exhibit. The source of the data was the Health Coverage Portal TM, a market database maintained by Mark Farrah Associates, which includes information from the NAIC. Actual rebates will be based on reports insurers submit to the federal government later this year.
  3. Mercer, “National Survey of Employer-Sponsored Health Plans,” November 2011.
• Update on MLR impact on brokers
  1. NAIFA, “New NAIFA Survey: Health Agents and Consumer Hurt by MLR,” conducted April 11-13, 2011. http://www.naifa.org/documents/MLRSurveyKeyFindings.pdf
• High-risk pool ends broker fees
  1. The Washington Post, “The high risk of high-risk pools,” by Sarah Kliff, January 12, 2012.
  2. PCIP portal, “Broker referral payment program,” April 2012.
  3. Centers of Medicare and Medicaid Services, “Covering people with pre-existing conditions: Report on the implementation and operation of the pre-existing condition insurance plan program,” February 23, 2012.
• Latest update on Essential Benefits data collection
  
  1. Truven, “White Paper: Modeling the Impact of “Pay or Play” Strategies on Employer Health Costs,” by Christopher Justice, MS, July 2012
  2. Mckinsey, “How US health care reform will affect employee benefits,” June 2011.
  3. Deloitte, “2012 Deloitte Survey of U.S. Employers,” July 2012.
  4. Lockton, “Employer Health Reform Survey Results,” June 2011.
  5. Truven, “White Paper: Modeling the Impact of “Pay or Play” Strategies on Employer Health Costs,” by Christopher Justice, MS, July 2012.
• Department of Labor provides new, temporary guidance on 90-day waiting period limit
  1. U.S. Department of Labor, “DOL Technical Release 2012-02: Guidance on 90-day Waiting Period Limitation Under Public Health Service Act § 2708,” August 31, 2012. All information in this article taken from this source.
• Determining who’s a full-time employee
  1. Internal Revenue Service, “Determining Full-Time Employees for Purposes of Shared Responsibility for Employers Regarding Health Coverage (§ 4980H): Notice 2012-58,” September 2012. All information in this article taken from this notice.
• Study suggests PCIP may not be a sustainable solution for people with pre-existing conditions
  1. Jean P. Hall and Janice M. Moore, Realizing Health Reform’s Potential, The Commonwealth Fund, September 2012. All material in this article taken from this source unless otherwise noted.
• Confusion about preventive coverage under health care reform
  1. The Henry J. Kaiser Family Foundation, American Cancer Society, and National Colorectal Cancer Roundtable, “Coverage of Colonoscopies Under the Affordable Care Act’s Prevention Benefit” (September 2012). All information in this article taken from this study.
• Health care implementation moves forward
  1. Kaiser Health News, “Facing Deadline, Most States Say No to Running Their Own Insurance Exchanges” (Dec. 14, 2012; accessed Dec. 28, 2012), http://capsules.kaiserhealthnews.org/index.php/2012/12/facing-deadline-most-states-say-no-to-running-their-own-insurance-exchanges/ .
  2. Alex Wayne, “Health Exchanges to Be Run by 18 States as Most Governors Pass,” Bloomberg.com (Dec. 17, 2012; accessed Dec. 28, 2012), http://bloom.bg/Uu8o6e.
  3. Kathleen Sebelius, “States Moving Forward to Implement the Health Care Law,” Healthcare.gov (Dec. 17, 2012; accessed Dec. 28, 2012), http://www.healthcare.gov/blog/2012/12/states-moving-forward121712.html.
  4. Henry J. Kaiser Family Foundation, State Health Exchange Profiles (2012, accessed December 28, 2012), http://healthreform.kff.org/State-Exchange-Profiles-Page.aspx
• Regulators begin work on “navigator” licensing framework
  1. Allison Bell and Elizabeth D. Festa, “NAIC Panel Develops Navigator Licensing Framework,” LifeHealthPro (Dec. 13, 2012; accessed Dec.28, 2012), http://www.lifehealthpro.com/2012/12/13/naic-panel-develops-navigator-licensing-framework.
  2. U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services, Center for Consumer Information & Insurance Oversight, “Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges” (Aug. 14, 2012; accessed Dec. 28, 2012), http://cciio.cms.gov/resources/files/hie-blueprint-081312.pdf.
• HHS responds to questions about key health care reform provisions
  1. Timothy Jost, “Implementing Health Reform: No Partial Medicaid Expansion With 100 Percent Federal Match and Other Answers,” Health Affairs Blog (Dec. 11, 2012; accessed Jan. 4, 2012), http://healthaffairs.org/blog/2012/12/11/implementing-health-reform-no-partial-medicaid-expansion-with-100-percent-federal-match-and-other-answers/.
  2. “U.S. — Health Care Reform Bulletin: HHS Says No to Partial Medicaid Expansions, Conditionally Approved Six State-based Exchanges,” Towers Watson (Dec. 2012; accessed Jan. 4, 2012), http://www.towerswatson.com/united-states/newsletters/health-care-reform-bulletin/8697.
  3. Fickewirth Benefit Advisors, “FAQs on Exchanges, Market Reforms and Medicaid,” Fickewirth AnswerPoint Legislative Brief (2012; accessed Jan. 4, 2012), http://www.fickewirth.com/cmsAdmin/uploads/pressroom/faqs-on-exchanges-market-reforms-and-medicaid.pdf.
• Essential Health Benefits and other key features
  1. Allison Bell, "PPACA Rate, Wellness and Benefits Proposals Roll Out," LifeHealthPro (Dec. 3, 2012; accessed Jan. 2, 2013), http://www.lifehealthpro.com/2012/12/03/ppaca-rate-wellness-and-benefits-proposals-roll-o.
  2. Department of the Treasury, Department of Labor, Department of Health and Human Services, "Incentives for Nondiscriminatory Wellness Programs in Group Health Plans" (Nov. 26, 2012; accessed Jan. 2, 2013), http://www.dol.gov/ebsa/pdf/wellnessproposedregulation.pdf.
• Health Care Exchange Updates
  1. Department of Health and Human Services, Centers for Medicare and Medicaid Services, "Affordable Insurance Exchanges Guidance: Guidance on the State Partnership Exchange" (Jan. 3, 2013; accessed Feb. 21, 2013), http://cciio.cms.gov/resources/files/partnership-guidance-01-03-2013.pdf.
  2. Bell, Allison, "CMS Posts Exchange Producer Registration Drafts," LifeHealthPro (Feb.7, 2013; accessed Feb. 21, 2013), http://www.lifehealthpro.com/2013/02/07/cms-posts-exchange-producer-registration-drafts.
• Health Insurance Exchange notice requirements delayed
  1. Zane Benefits, "Employer ACA Exchange Notice Requirement Delayed" (Jan 17, 2013; accessed Feb. 21, 2013), http://www.zanebenefits.com/blog/bid/259794/Employer-ACA-Exchange-Notice-Requirement-Delayed
• For large employers, "pay or play" extends to dependent children
  1. Robert Pear, "Employers Must Offer Family Care, Affordable or Not," The New York Times (Dec. 31, 2012).
  2. Janet Adamy, "Under Health Law, Employers Must Insure Workers' Dependents," The Wall Street Journal (Dec. 28, 2012).
• Health care reform delay means limited plan choices for small businesses
  1. Cyrus Afzali, "Small Businesses Won't Have Plan Choices Under Obamacare," Newsmax (Apr. 1, 2013; accessed April 8, 2013), http://www.newsmax.com/Newsfront/obamacare-small-business-plans/2013/04/01/id/497296
  2. Robert Pear, "Small Firms' Offer of Plan Choices Under Health Law Delayed," The New York Times (Apr. 1, 2013).
• Proposed rules released for Navigator role
  1. Kathryn Mayer, "Feds Release Rules for Exchange 'Navigators,'" BenefitsPro (Apr. 3, 2013; accessed Apr. 8, 2013), http://www.benefitspro.com/2013/04/03/feds-release-rules-for-exchange-navigators
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     BenefitsProNewsAlert&utm_medium
     =eNL&utm_campaign=BenefitsPro_eNLs&_LID=86933954
  2. "Proposed Rule: Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel," Federal Register (Vol. 78, no. 66, 2013).
  3. "Proposed Rule: Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel," Federal Register (Vol. 78, no. 66, 2013).
• Potential Health Insurance Exchange participants have until April 30 to apply
  1. Allison Bell, "Official: Federal Exchange Plan Bids Due April 30," LifeHealthPro (Feb. 14, 2013; accessed April 8, 2013), http://www.lifehealthpro.com/2013/02/14/official-federal-exchange-plan-bids
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     medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=86933848&t=
     individual-health&page=2
• Basic Health Plan implementation delayed to 2015
  1. Deborah Bachrach et al., Focus on Health Reform — The Role of the Basic Health Program in the Coverage Continuum: Opportunities, Risks, and Considerations for States (The Henry J. Kaiser Family Foundation, 2012).
  2. The Herschel S. Horowitz Center for Health Literacy, "HHS Delays Basic Health Plan Option Until 2015," University of Maryland (Feb. 8, 2013; accessed Apr. 8, 2013), http://www.healthliteracy.umd.edu/hhs-delays-basic-health-plan-option-until-2015/.
  3. The Herschel S. Horowitz Center for Health Literacy, "HHS Delays Basic Health Plan Option Until 2015," University of Maryland (Feb. 8, 2013; accessed Apr. 8, 2013), http://www.healthliteracy.umd.edu/hhs-delays-basic-health-plan-option-until-2015/.

• “Pay or play” podcast
  1. Lockton, Employer Health Reform Survey Results (2011).
  2. Aon Hewitt, Corporate Health Care Exchange Survey — The Time is Now: Rethinking Health Care Coverage (2012).