As you already know (after all, you are reading this blog for heaven’s sake), not enough time exists to permit analysis of the many new rules and interpretations and guidance on health care reform. Barely enough time exists to catalog the changes. Therefore, I present below a laundry list of change in May with links to the documents so that you might abandon more uplifting pursuits in favor of the intellectual boredom and frustration and anger derived from reading health reform laws.

Before I provide the laundry list, I want to again lean on history to clarify what federal health care reform means in Washington State. Cocktail parties have turned into a two drink minimum for me as I listen to the improvements federal health care reform has brought to Washington health plan markets like community rating, limits on preexisting conditions, coverage of dependents, non-discrimination against providers, network regulation, minimum loss ratios, blah, blah, blah, blah.

Yes, consumers will see some changes but many of the claimed improvements were made by Washington legislators a long time ago, ten to fifteen years before federal reform (so last century).

Here are the laws that governed Washington health plan markets before federal health care reform and the statutory/regulatory links for those who doubt the preexisting condition of the state law.

(P.S. Don’t let me forget to mention that Washington will move forward with its SHOP exchange with only a single carrier writing primarily in one corner of the state.)


Brief list of Washington laws predating federal health care reform:

  • Guaranteed issue and renewal of group health plans with exceptions for very sick people purchasing individual plans. (RCW 48.43.035)
  • Limits on preexisting health condition limits in group and individual health plans. (RCW 48.43.012 & 48.43.015)
  • Guaranteed renewal of individual health plans. (RCW 48.43.038)
  • Guaranteed issue of individual plans except for those failing the state designed health questionnaire. (RCW 48.43.018)
  • Minimum benefit standards for individual health plans including maternity and prescription drug benefits. (RCW 48.43.041)
  • Dozens of required health plan benefits ranging from access to particular types of health care practitioners to particular types of health care. You can find a list on the Insurance Commissioner’s website here.
  • Prohibition on insurer exclusion of particular types of health care practitioners – non-discrimination in health care delivery. (RCW 48.43.045)
  • Mandatory health care practitioner dispute resolution process. (RCW 48.43.055)
  • Mandatory consumer dispute resolution process including independent outside review of insurer coverage denials. (RCW 48.43.530 & 48.43.535)
  • Right of individuals, plans, and health care providers to object to services that violate religious beliefs. (adopted in 1995 – RCW 48.43.065)
  • Regulation of health care networks and freedom of individuals to obtain the care of their choosing. (RCW 48.43.085, .087, .515, and WAC 284-43-200)
  • Women’s right to access the care they need from the type of practitioner they choose. (adopted in 1998 – WAC 284-43-250)
  • Right of parents to cover dependents until age 26. (federal reform added a year – RCW 48.43.215)
  • Community rating for individual and small group plans except for associations. (adopted in 1995 – RCW 48.43.022)
  • Minimum loss ratios (plans have to return a minimum amount of benefits for the price of coverage) (e.g., RCW 48.44.017 & WAC 284-60-060)
  • _______________________

You get the point. Federal health care reform is great for consumers in state’s with few laws; but, that hasn’t been a problem in Washington state. Parenthetically, health care reforms in Washington were enacted with Republican majorities, Democrat majorities, and mixed majorities. So, please, forgive me for not singing the praises for stuff we already had before “REFORM.” On to the May laundry list.

May was dominated by the long and tedious debate over whether small employers could keep grandfathered coverage purchased through associations. The fed says yes, the OIC says no, and now the OIC may get to “yes but.”

“The Office of the Insurance Commissioner will be hosting an All-Filers Meeting/Webinar regarding Association Health Plans. The focus of this meeting will be on the steps carriers must take to transition their AHP business in 2014. The meeting/webinar will take place on Thursday, June 6th from 2:00 – 4:00 pm (PDT) here in our offices in Tumwater.” [OIC blast email 5/28/2013]

By the way, “All-Filers” meetings is where the rubber hits the regulatory road in Washington State. These meetings “explore the nuances of regulatory compliance” which is the gentlest way I can describe these “informational sessions.” Here is a sample from last Friday in which carriers were given instructions on how to complete work for filing new plans and filling out “templates” created for the NEW MARKETPLACE. I often refer to these as regulation by PowerPoint. My God, am I glad I don’t do rates and forms for a living.

Here are the OIC actions for May:

Electronic Response to OIC regarding consumer complaints

Geographic rating areas for individual and small group health plans

→ Security breach notification to the OIC

→ New information privacy rule considered

→ Insurer “allocation accounts” for segregation of premiums for coverage of abortion services


So, that was just the official state OIC regulatory action. I’ll report on the new legislative actions later. (Seriously, someone should let my wife know that I only work; I am not playing video games here.)

Here are the federal regulations published in May.

→ Workplace wellness programs

→ More federal FAQs on reform

→ IRS Premium Subsidy Regulations

→ New exchange applications for individuals, individual subsidy, and families

Preexisting insurance plan regulations

Early retiree reinsurance program regulations

Guidance on use of agents and brokers in Exchanges

Guidance on SHOP exchange

Model Individual Market Renewal Notices

Guidance on MLR for fixed indemnity plans


Of course don’t forget to read the regulations from April, March, February, January….good luck and goodnight to lawyers everywhere! My sympathies to everyone else.