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Analysis: Oklahomans' insurance rates average $143 to $673 under Affordable Care Act

Penulis : Daisi Ketiku on Sunday, September 15, 2013 | 3:53 PM

Sunday, September 15, 2013

Health insurance rates offered by the state's largest insurer under the Affordable Care Act will average $143 per month for a 30-year-old with basic coverage to $673 per month for a 64-year-old who wants the best coverage, a Tulsa World analysis shows.

Consumers can choose from nearly 150 plans offered by three companies through the state's new Affordable Care Act "exchange," a website where they can compare plans and prices. The three participating companies list average monthly premiums ranging from $232 to $332, records show.

Enrollment in plans offered under the new law begins Oct. 1 and continues for six months. Coverage starts Jan. 1.

Blue Cross Blue Shield of Oklahoma expects nearly 100,000 currently uninsured Oklahomans to buy its plans, according to the company's rate filings. The state ranks fifth nationally in the number of uninsured residents, with more than 600,000 people lacking health insurance.

Melissa Parchman, an insurance broker who owns Magoon & Associates in Tulsa, said people comparing plans under the new law need to check details such as the list of providers and prescription formularies. Parchman has lobbied in Washington for health-care reform and has created a website explaining details of the Affordable Care Act.

"Consumers should look at any plan they are considering and make sure their doctor is in the network," she said. "The smaller the network, the lower the premium (will be). People need to be very, very careful about that."

Five companies

Plans will be offered through the exchange by five companies: Blue Cross Blue Shield of Oklahoma, Coventry Health and Life Insurance, Aetna Life Insurance, CommunityCare, and GlobalHealth. Two of the companies - Aetna and Coventry - have merged in recent months but plan to offer insurance under both corporate names, according to the state Insurance Department.

The World analyzed hundreds of pages of rate filings that Blue Cross Blue Shield, Coventry and Aetna submitted to the state last week. Those companies plan to offer "preferred provider" plans in the state's insurance exchange.

Rate filings for CommunityCare and GlobalHealth were not released because, as health maintenance organizations, they are not subject to the same disclosure requirements. Rates for HMOs - which use a primary care physician to make referrals to specialists - are generally lower than preferred provider rates.

Parchman said people who have never had insurance before should consider one of the HMO plans.

"You have a primary care doctor who works as a gatekeeper and manages all of your health care for you ... and can guide you to the next doctor if you need a specialist," Parchman said.

Various rates

The federal government has given grants to several Oklahoma organizations to train "navigators" who will help people enroll in coverage.

The World's analysis focused only on Blue Cross Blue Shield rates because of the differing formats in which companies submitted their rates and because the company insures nearly two-thirds of the state's individual market.

The World analyzed Blue Cross Blue Shield rates in all exchange plans for three scenarios: single nonsmoking adults ages 30, 50 and 64. Families may also buy coverage under the law, and prices for children are far lower than those for adults.

The rate filings do not include federal subsidies available under the law, which could dramatically lower the cost for many people. For example, a 30-year-old nonsmoker making the state's median income would pay less than half of the annual premium for a policy after subsidies are applied, or about $121 per month.

Individuals making up to $45,960 per year and families with incomes of $94,200 can qualify for a subsidy to purchase insurance under the law if their employers do not offer affordable insurance.

In the exchanges, plans are generally grouped under four categories: platinum, gold, silver and bronze.

People purchasing the silver plan, which pays about 70 percent of health-care costs, may qualify for reduced co-pays and other cost sharing in addition to premium discounts if they make $28,725 or less per year.

Companies offering coverage under the new law must offer certain "essential health benefits" and cannot turn away people due to pre-existing conditions.

People younger than 30 and those with low incomes may also qualify for a "catastrophic" coverage plan.

Blue Cross' lowest rate in the World's analysis was $108 a month for a 30-year-old in the Comanche County area choosing the bronze plan, which pays about 60 percent of health-care costs. The company's highest rate was $807 a month for a 64-year-old living in the Oklahoma County area choosing a gold plan, which pays about 80 percent of health-care costs.

The highest average rates for all plans the company filed under the new law were in the Tulsa area. Thirty-year-olds in the Tulsa area would pay an average of $211 per month, and 64-year-olds would pay an average of $559 per month.

The lowest average rates for Blue Cross Blue Shield plans were in the Comanche County area.

Companies consider mortality rates when setting insurance rates for a particular area. The uninsured population has a higher risk and higher mortality rate than those who currently have insurance, the rate filings state.

According to the World's analysis, the lowest-cost Blue Cross plan for a 30-year-old in the exchange costs an average of $143 per month. The same bronze plan would average $225 for a 50-year-old and $378 for a 64-year-old. The figures do not include subsidies.

Educating Oklahomans

Blue Cross Blue Shield's filing estimates that of the 624,000 people lacking health insurance in Oklahoma, about 224,000 of those will purchase coverage through the exchange.

That figure excludes illegal immigrants and people with incomes too high to qualify for subsidies and assumes that about 60 percent of the remaining uninsured population will buy coverage through the exchange.

The law contains an "individual mandate" requiring people to have health insurance or pay a fine unless they fall into an excluded category.

The fine for an individual begins at $95 next year and escalates to $695 in 2016 but could be higher depending on household income.

People may have insurance through their employer or have coverage through programs such as Medicare, Medicaid, tribal health care or a military plan in order to comply with the mandate.

In an email statement to the World, Blue Cross Blue Shield of Oklahoma spokeswoman Ashley Hudgeons said the company will be working to help educate people about the new health-care law.

"We understand health insurance can be confusing at times, and that is why we strive to provide the best service to our current and potential members to help them make the best health-care decisions for themselves and their families," Hudgeons said.

The company and others planning to offer coverage under the law have stepped up publicity in recent weeks, with mall kiosks, their own websites and booths at community events.

Frank Stone, chief actuary at the state Insurance Department, said the agency talked with companies planning to offer coverage under the new law about how the new rates compare to current individual market rates. Stone said that is how the agency came up with its estimate of increases ranging from 30 percent to 100 percent.

But those estimates do not take into account the subsidies that will be available under the law or expanded benefits due to the law's requirements. Health policy groups including the Henry J. Kaiser Family Foundation of California and Washington, D.C., have cautioned against comparing current rates to rates offered under the new law because of the subsidies and differences in plans.


Mike Rhoads, Oklahoma's deputy commissioner of life and health insurance, said the law will offer some uninsured Oklahomans a chance to buy health insurance for the first time.

"Whether or not it's affordable remains to be seen," Rhoads said. "At the end of the day, even at a maximum subsidy, everybody has to pay a premium. So at $50 a month, if that's what it's going to cost them, is $600 a year still affordable?"

Insurance Commissioner John Doak and other state officials have been highly critical of the sweeping federal health-care-reform law. Attorney General Scott Pruitt is suing the federal government, claiming that Oklahoma and other states that did not create their own exchanges - which were imposed on them by the federal government - are exempt from the law.

Because the state rejected an expansion of Medicaid, thousands of low-income Oklahomans will not qualify to buy subsidized insurance under the new law. A one-year extension of Insure Oklahoma allows about 30,000 people to maintain coverage through that program, but it is capped at 35,000 people.

Jonathan Small, fiscal policy director for the conservative policy group Oklahoma Council of Public Affairs, said the law has "serious flaws" that will lead to higher health insurance rates.

"A credit or subsidy doesn't lower the cost of an item or product. ... This makes our three-party health-care system worse by introducing a fourth party and even masking costs."

The subsidies are paid by taxes and fees on insurance policies, including nearly 5 percent of the premium for a high-risk pool and administrative costs.

"The problem is, it's insurance, and we've forgotten that insurance is supposed to be an exchange of potential risk for a dollar amount in the hopes from both parties that risk never happens," Small said.

Rate details

Rate filings were released last week for three companies seeking to offer coverage on the Affordable Care Act exchange website in Oklahoma. The companies and two others - CommunityCare and GlobalHealth - are expected to offer plans through the new health-care law.

Because health maintenance organizations, or HMOs, are not required to publicly disclose such filings, rate information for CommunityCare and GlobalHealth has not yet been made public.

Below are selected details taken from the filings. Average premiums will differ according to geographic area, age, smoking status and percentage of health-care costs paid by the plan. Some rates include plans offered outside the exchange.

Blue Cross Blue Shield of Oklahoma

Average monthly premium: $232

Expected 2014 premiums earned: $466.7 million

Expected 2014 claims: $435.1 million

Aetna Life Insurance Co.

Average monthly premium: $332

Expected 2014 premiums earned: $3.3 million

Expected 2014 claims filed: $2.4 million

Coventry Health and Life Insurance Co.:

Average monthly premium: $312

Expected 2014 total premiums earned: $2 million

Expected 2014 total claims filed: $1.6 million

Ziva Branstetter 918-581-8306

Original Print Headline: Oklahomans' insurance rates to vary
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Deadline looms for Neb. insurance marketplace

— Community groups are hustling to meet an Oct. 1 deadline to launch a new health insurance marketplace in Nebraska, a key piece of the federal health care law designed to steer users toward a coverage plan.
Nebraska state officials have maintained a hands-off approach to the marketplace, which requires hiring and training a small army of experts to guide newcomers through the process. Gov. Dave Heineman rejected a state-run option in November, saying it was too expensive for Nebraska taxpayers, so the federal government took charge of setting it up.
The responsibility for training the insurance "navigators" has fallen to two groups: Community Action of Nebraska, a nonprofit that has local offices in all 93 counties, and the Ponca Tribe of Nebraska, which will offer services primarily to American Indians. Both have received one-year federal grants to hire navigators. Nationally, the effort to establish navigator services includes more than 100 nonprofits and other organizations, which specialize in everything from running soup kitchens to organizing farm workers.
Officials with Community Action of Nebraska said they're confident they'll meet the deadline, but caution that early kinks could slow the service during the first days.
"Our biggest concern is there are so many pieces," said Roger Furrer, executive director of Community Action of Nebraska. "The car is being built as it goes down the road. Everyone has to get all of the pieces in line, all at the same time, for this to work really well."
Another concern is the effort to reach groups that typically haven't sought coverage: Low-income residents who don't qualify for Medicaid, and the so-called "young invincible" population of healthy males in their 20s and 30s, who don't believe they need coverage.
Community Action of Nebraska is training 52 navigators, and plans to have 62 in place once the marketplaces open, Furrer said. The agency's goal is to bring some 42,000 uninsured residents into the marketplaces, which allow consumers to comparison shop for health insurance and see whether they qualify for federal subsidies. The group has received a $562,000 federal grant.
Furrer said the group also has concerns that people who might benefit from the marketplaces will wait until the last minute. Procrastination could lead to gaps in coverage, even for high-risk customers who are expected to lose state coverage because they will qualify for the federal exchange. The 15th of each month serves as a cutoff: A consumer who enrolls on Jan. 5 will receive coverage starting Feb. 1, but a person who enrolls on Jan. 16 will end up waiting until March 1.
The Nebraska Department of Insurance has deferred to the federal government when it comes to advertising the health insurance marketplace, said Bruce Ramge, the agency's director. Ramge said the department will have a limited role in the marketplaces but will keep a list of registered navigators to protect against fraud.
The navigators-in-training include case managers who already work for the nonprofit agency, in addition to new staff members hired in local offices, Furrer said. They receive 20 hours of training, then must pass an exam and register with the Nebraska Department of Insurance.
Nebraskans who receive coverage through the state's comprehensive, high-risk insurance pool are slated to lose their state coverage on Jan. 1. Furrer said the state has already notified those residents that they'll need to enroll in the marketplaces by Dec. 7 at the latest to maintain continuous coverage. Shifting them into the exchange is expected to provide a net cost savings for the state.
The Ponca Tribe of Nebraska has received a $37,500 federal grant to cover the cost of a single, part-time navigator. The tribe also plans to train between eight and 12 members of its regular staff to serve as navigators. Two have completed the training so far, and the tribe is on schedule and expects to meet the Oct. 1 deadline, said Tina Villalpando, a contract health specialist for the tribe in Norfolk.
Villalpando said the tribe's service area includes more than 14,000 American Indians and Alaska Natives, including about 4,500 who are uninsured. Those residents are scattered in 12 counties in Nebraska, two in Iowa and one in South Dakota. It also extends to other tribes whose members live in the service area.
"Our goal is to reach as many people in this population as possible in the one year that the grant provides funds," she said. "Afterward, our staff will continue to reach out to people who access tribal health and social services."
Villalpando said the tribe could face challenges reaching out to some members, who might have limited access to the Internet or phone service, or who change addresses frequently. But she said the tribe also enjoys a supportive family and community network that could help spread word about the enrollment process.
Lawmakers this year formed a stakeholder commission to give input to the federal government as it creates and oversees Nebraska's exchange. The commission includes consumers, health care providers, insurance carriers and agents.
Mike Groene, a citizen member appointed by Heineman, said he preferred that the state take as little action as possible to avoid duplicating the federal government's efforts. Groene also questioned whether the marketplaces would succeed in attracting as many people as intended.
"I don't think our (state) Insurance Department should spend a lot of time worrying about the federal mandates," said Groene, also the president of the Western Nebraska Taxpayers Association. "I'm not criticizing the people here who are involved, because they're good people. But if the federal government wants to do it, let them do it. We shouldn't lose sleep over it."

Read more here: http://www.kansascity.com/2013/09/15/4483207/deadline-looms-for-neb-insurance.html#storylink=cpy
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Insurers limiting doctors, hospitals in health insurance market

Insurers in California's new health insurance exchange are holding down premiums by limiting choices, raising concerns that patients will struggle to get care.

Cedars-Sinai Medical Center
Major insurers have limited the number of doctors and hospitals available in California's new health insurance market. Cedars-Sinai Medical Center, for example, is available only on two lower-priced Health Net plans in the state-run market. (Kirk McKoy / Los Angeles Times)

The doctor can't see you now.
Consumers may hear that a lot more often after getting health insurance under President Obama's Affordable Care Act.
To hold down premiums, major insurers in California have sharply limited the number of doctors and hospitals available to patients in the state's new health insurance market opening Oct. 1.
New data reveal the extent of those cuts in California, a crucial test bed for the federal healthcare law.
QUIZ: How much do you know about health care?
These diminished medical networks are fueling growing concerns that many patients will still struggle to get care despite the nation's biggest healthcare expansion in half a century.
Consumers could see long wait times, a scarcity of specialists and loss of a longtime doctor.
"These narrow networks won't work because they cut off access for patients," said Dr. Richard Baker, executive director of the Urban Health Institute at Charles Drew University of Medicine and Science in Los Angeles. "We don't want this to become a roadblock."
To see the challenges awaiting some consumers, consider Woodland Hills-based insurer Health Net Inc.
Across Southern California the company has the lowest rates, with monthly premiums as much as $100 cheaper than the closest competitor in some cases. That will make it a popular choice among some of the 1.4 million Californians expected to purchase coverage in the state exchange next year.
But Health Net also has the fewest doctors, less than half what some other companies are offering in Southern California, according to a Times analysis of insurance data.
GRAPHIC: Prices in California's health exchange
In Los Angeles County, for instance, Health Net customers in the state exchange would be limited to 2,316 primary-care doctors and specialists. That's less than a third of the doctors Health Net offers to workers on employer plans. In San Diego, there are only 204 primary-care doctors to serve Health Net patients.
Other major insurers have pared their list of medical providers too, but not to Health Net's degree. Statewide, Blue Shield of California says exchange customers will be restricted to about 50% of its regular physician network.
In response, California officials have been pressing Health Net and other insurers to add more doctors since companies filed their initial rosters in May. The state exchange, Covered California, says it will monitor enrollment closely once it begins next month and it's prepared to step in if problems arise.
"Our interest is in assuring everyone enrolled in a plan has ready access to the clinicians they need," said Peter Lee, executive director of Covered California. "That means if a plan can't serve patients, we'll close it down from taking new enrollment. That is in some ways the nuclear option."
Rather than mere head count, officials say they are scrutinizing what capacity physicians have to accept new patients. And to assist consumers, California will enable people to search for specific doctors online during enrollment to determine what, if any, health plans they will be part of in Covered California.
"Does the doctor have room for one more patient or 40 patients? It's about available seats," Lee said. "We want to make sure every network has enough doctors."
Health Net says price will probably matter most to the uninsured and people who buy their own health insurance now, so it built a narrow network to serve those "value seekers."
"We have more than enough doctors for our projected enrollment through 2014, and we have time to adjust if it becomes necessary," Health Net spokesman Brad Kieffer said. "We continue reaching out to providers, and we are bringing more on board."
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16 and up can’t afford to track out Obamacare insurance plan requirement

Penulis : Daisi Ketiku on Saturday, September 14, 2013 | 10:13 PM

Saturday, September 14, 2013

Before passage with the Affordable Attention Act, becoming a adult meant having kicked towards curb as soon as it reached health insurance coverage.

“Our gift when people turned 20 was to take away their medical health insurance, ” explained Karen Pollitz, a older fellow at the Kaiser Household Foundation. “Turn 20 and we kick these individuals out. ”

In case you were inside college, you could usually continue to your parents’ insurance before you turned 25. But until finally health-care reform took place, young grownups who didn’t uncover jobs with health coverage or competent for authorities insurance have been often still left uninsured and liable to massive health-related bills.

Now there’s something special awaiting young adults.

Thanks towards ACA, commonly referred to as Obamacare, you may well now get insurance or continue being covered within a parent’s plan up to the age of 26. This also coverage can be purchased even if you’re hitched, not living in the home, attending college or tend to be financially self-sufficient. Starting subsequent year, young adults up to be able to 26 can continue to their parents’ workplace plan even if they get another offer of coverage via an employer.

The downside for some parents is which they might have to pay extra to help keep young adult children included. But at least they will have insurance.

And, in a few weeks, a brand new marketplace will open on www. health care. gov, giving young adults, particularly those much older than 26, another alternative for obtaining medical health insurance. Trust me, this is usually one buying trip you need to go upon.

There is usually concern that there are not enough young balanced adults will buy insurance plan, which can help offset the price of those that are older and also sicker all of which will need a lot of health-care services. Some authorities believe these kinds of concerns tend to be overstated. They realize that insurance plans inside new marketplace will give you a core group of benefits including hospitalization, maternal dna and infant care, mental health and substance-use condition services, and prescription drugs.

With the aid of trained employees called navigators, insurance shoppers will be able to compare plans determined by factors including price and also benefits. They’ll also have the capacity to determine as long as they qualify with regard to subsidies to help pay with the coverage.

While you’re youthful and balanced, you may well think you can put away from getting insurance plan. Maybe dollars is tight and you figure this really is something you can delay before you get old, like triggering a old age plan.

“Health insurance plan is something at this time I think I can’t afford, ” explained Josh Nece, twenty nine, a diner server inside Oakland, Calif.

Nece, who is afflicted with severe eczema, states that with rent, transportation, education loan payments along with expenses, he couldn’t afford the price of insurance on his own. But they needs insurance to help pay with the medication and also doctor appointments when his / her eczema fails out. He states that he frequently goes with no treatment or drugs because they can’t afford it.

He plans to check out the current market in his / her state. I’m going to follow upward with him to view if they does.

“I’m sure I’m going to get medical health insurance, ” they says. “Going in my 30s, I understand it’s one of many adult things I must do. ”

Within June, Kaiser asked young adults whether that they wanted and also valued medical health insurance. The answer was the resounding indeed, contrary towards conventional information about young adults feeling there're invincible.

Even now, for people that think they might wait, here’s something to wonder: A crash off the skateboard could finish up costing people $20, 000, because it did with regard to Pollitz’s 22-year-old kid, who works in your free time in the day-care middle.

“He strike a rock, and this skateboard slid within him, ” the lady said. “He smashed his hand. ”

Pollitz explained the payment was the “teachable time. ” Fortunately, he has been covered upon his parents’ plan. Otherwise, “that will be a financial disaster for them. ”

It is stories such as hers that leave Pollitz fervent about getting out the expression to young adults to get medical health insurance. Although most young adults already get coverage, a lot more than 19 million lack basic medical health insurance. In 2011, 35. 9 % of Us citizens ages 20 to 30 were uninsured. About the same percentage inside 25-to-34 age bracket also didn’t get insurance, as outlined by Kaiser.

Some young adults might not really get medical health insurance because this penalty with regard to not getting it isn’t hard enough. If the federal government determines you are in the budget to pay for coverage and you don’t fall under an exemption, you’ll should pay the penalty internet marketing uninsured when you file your own federal income tax. The penalty starts subsequent year on $95 annually to have an individual and can go up to $285 to get a family, or 1 percent of a family’s house income, depending on which is usually higher.

I enjoy believe millennials tend to be smart enough to understand they can’t afford not to get medical health insurance. It’s a present that is able to keep them not just healthy, but out of medical debt.
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Obama Management Bashes Florida for Blocking Health insurance Navigators

Florida was powerfully criticized by the us government on Thursday for barring outreach staff, known as “navigators, ” from region health departments whenever they start enrolling people next month for insurance below President Barack Obama’s professional medical reform law.

“This is another blatant and shameful seek to intimidate groups who will be working to inform Americans about their new medical health insurance options and help them take

He was talking about a directive in the Florida Department associated with Health, issued to neighborhood health department directors through the state earlier that week. “Navigators will not necessarily conduct activities on the basis of the health business units, ” it explained.

The directive comes resistant to the backdrop of a good aggressive effort through Florida Governor Rick Scott and also other Republican leaders inside state to weaken the Affordable Proper care Act, which is popularly often known as Obamacare.

Republicans point out the healthcare regulation will hurt work creation, while supporters visualize it as a landmark initiative that could extend health coverage to millions associated with Americans.

The application stakes are massive in Florida, the location where the U. S. Census Bureau says you will discover about 3. 8 million people without medical health insurance. That amounts to roughly one fourth of Florida’s populace, giving it the third-highest rate near your vicinity.

In a affirmation clarifying the navigators directive with Wednesday, the state well being department said the counselors trained to assist people join health insurance are barred, at least in part, in the fascination of consumer protection.

“This (Navigator) method has raised privacy concerns as a result of consumer information which will be gathered for used in a federal data source, ” the affirmation said.

Similar concerns are raised by Scott along with Florida Attorney Basic Pam Bondi, amid allegations in which navigators might steal private information, but they are rejected beyond control by the U. S. Health along with Human Services Division.

U. S. Agent Kathy Castor, a new Florida Democrat, said hampering the task of navigators ended up being a “plain absurdity” inside a harshly worded letter she fired off of to Scott with Thursday.

“The continued blockage by you and many state leaders from the Affordable Care Act is unlike the best interests from the citizens and businesses of Florida, ” Castor explained.

“To deny access to Navigators to well being departments is another obstructionist measure in which elevates ideology above the interests of Floridians who should just see a medical doctor or nurse along with take personal responsibility through signing up for affordable insurance, ” she said.

U. S. Health and Human Services Department officers say the Florida restrictions will never impede the method. “Despite the state’s makes an attempt, we are assured that Navigators it's still able to help Floridians take quality, affordable health coverage when open application begins on Oct 1, ” Garnishment said.
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Question Of The Day: Politics Aside, Is Obamacare Secure?

Penulis : Daisi Ketiku on Friday, September 13, 2013 | 10:23 AM

Friday, September 13, 2013

It's the biggest change in health care in nearly half a century, and perhaps unsurprisingly it's already become a tool for scammers. Though open enrollment under the Affordable Care Act (aka Obamacare) doesn't begin until Oct. 1, scam artists - masquerading as government representatives -- have tricked a number of consumers into coughing up personal information over the phone. That's just the opening shot. Once millions of consumers begin providing unprecedented amounts of personal data to various health exchanges through countless state and federal networks, the real assault will begin.
Hackers of all stripes are licking their chops in anticipation of a treasure trove of high value information ripe for the picking. The burning question: Are the data conduits secure? And what's at stake if your information is stolen? Best case: your financial well-being, if new accounts are opened in your name. Worst case: your life, if medical treatment is obtained in your name and your medical files are co-mingled -- leading to incorrect diagnosis and treatment. (If you're worried that someone has fraudulently opened accounts in your name, you should request copies of your medical records and look for errors. You can also use a free tool like Credit.com's Credit Report Card to monitor your credit for unexplained changes -- which could stem from unpaid bills for fraudulently obtained healthcare. If something doesn't seem right, you can dig deeper and get your three credit reports for free once a year.)
The politics of the Affordable Care Act are irrelevant. The issue for me is privacy and data security and whether you're for Obamacare or against it, there are two ways the program's rollout could put your personal information at risk:
A Potentially Insecure Data Collection Process
When it comes to keeping our information safe, the government appears to be playing a dangerous game of chicken.
An August report from the Inspector General revealed that the chief information officer for the Centers for Medicare & Medicaid Services, or CMS (which will run the data hub responsible for verifying applicants' personally identifying information with various federal agencies including the IRS and the Social Security Administration), won't sign off on data security until Sept. 30, one day before health insurance marketplaces are scheduled to open. That seems too close for comfort to me.
The Inspector General reported that such a tight deadline means the information chief "may not have a full assessment of system risks and security controls needed" to collect our data safely. Bottom line: The marketplaces are going live whether the data they gather is protected or not.
Optimists can take some comfort in the fact that, as CMS administrator Marilyn Tavener told Congress in July, the data hubs -- the focus of much partisan huffing and puffing -- are simply conduits. They are not databases, and will not retain any personal information.
Frankly, it's not as though the institutions currently gathering our data do a bang-up job protecting privacy, either.
"I don't want to say it will be better privacy-wise, but it can't be any worse," says my colleague Eduard Goodman, chief privacy officer of Identity Theft 911. "At least with a government program you will have some accountability."
That said, there is absolutely no room for trial and error when dealing with information so vital to our health and valuable to those who would steal and exploit it for their personal gain.
Lack of Proper Screening and Training
The federal government spent $67 million to hire "navigators" to help people enroll in Obamacare. As Health and Human Services Secretary Kathleen Sebelius told USA Today, navigators are needed to help consumers traverse the complicated world of private insurance, and dispel myths about the new program.
Many in the public and private sectors have expressed concern that navigators will have access to extremely sensitive personal information, including Social Security numbers, without proper screening, training and oversight required to prevent data loss or theft.
In a letter sent to the HHS Secretary less than one month ago, 13 attorneys general warned, "As it now stands, it is inevitable that HHS's vague 'standards' will result in improperly screened or inadequately trained personnel."
The administration counters that strong privacy measures exist already. The final rule implementing the program requires navigator agencies to be pre-screened and closely monitored. It argues that navigators will receive up to 30 hours of initial training that includes preparation on privacy and security; will be tested before starting work; will not have access to applicants' online accounts; and their work will be monitored by CMS.
The back and forth has continued, but the concerns expressed by congressional critics aren't entirely unfounded. No matter how much training and oversight they receive, navigators will have access to lots information about lots of Americans, and it is not unlikely that some may steal that data for their own profit.
We can do better. As the ID Theft Resource Center points out, all navigator applicants should undergo criminal background and fingerprint checks. Georgia, Utah and Nevada enacted tougher requirements on navigator certification and licensure. As long as such efforts don't devolve into obstructionism, states have broad power to protect Americans from fraud and, as the administration points out, should use that power.
Inevitably, some identity thieves will try to pose as navigators to scam consumers into handing over private information. Reports of scams have already surfaced. If you receive a call from anyone claiming to be a navigator, ask for their contact information, independently confirm their authenticity and then return the call. Search the CMS Center for Consumer Information & Insurance Oversight to locate those organizations in your state that are serving as navigators.
The Affordable Care Act represents a huge step forward in our drive to give all Americans access to health care. Unfortunately, if we fail to properly secure health information and protect patient privacy, the door will be open to identity thieves, hackers and scam artists thereby creating an environment of distrust and insecurity which will ultimately jeopardize the health of the program.
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Your Health Insurance Questions Answered

What is health insurance? Health insurance is a contract with an insurance company, which agrees to pay some or all of your medical bills based on your "coverage," or the terms of your policy. In exchange, the insurer is paid a set amount of money -- a "premium" -- on a regular basis. Most Americans have private health insurance, either through their employer's group plan or through buying their own individual policy. Others are covered under public "safety net" programs such as Medicare and Medicaid. Why do I need health insurance? It's no secret that health care is expensive today. The government says the cost to treat a broken leg can run $7,500 and an average three-day hospital stay can set you back $30,000. Without insurance, many Americans would be one health setback away from financial ruin. Regularly paying a set premium for health coverage assures that money will be available to defray the cost of everything from routine checkups to catastrophic medical bills. What's the difference between a deductible, a copayment and coinsurance? All three are medical charges you must pay out of your own pocket, even if you have insurance. Your deductible is the initial amount you must pay each year for covered health services before your insurer will start to chip in. Plans may have separate individual and family deductibles and/or deductibles for separate services such as hospitalization. A copayment is a fixed amount you pay toward each medical service, such as $25 for a checkup. Coinsurance is a fixed percentage, rather than a flat amount, that you pay toward each service. What is the Affordable Care Act, and why did we need it? The Patient Protection and Affordable Care Act, commonly known as Obamacare, was signed into law by President Barack Obama on March 23, 2010. It includes a broad range of reforms designed to make health insurance better and more affordable, rein in health costs and expand coverage among America's nearly 50 million uninsured. The act requires most Americans to have health insurance or face a penalty beginning in 2014. It also makes it illegal for insurers to set dollar limits on coverage, drop you if you get sick or charge more or deny coverage because of a pre-existing condition. Do I really have to buy health insurance in 2014? The Affordable Care Act's "individual mandate" requires all Americans, with a few exceptions, to have health insurance that typically offers "minimum essential coverage." Going without insurance could bring a tax penalty. For 2014, that penalty is 1% of your annual income or $95, whichever is higher, and $47.50 for each uninsured child, to a family cap of $285. The penalty increases to the greater of 2.5% of income or $695 per person by 2016. The penalty will show up as an additional tax or a reduction in your federal tax refund. I can't afford to buy health insurance. What should I do? Depending on your income, you may be eligible for lower-cost, subsidized coverage purchased through Obamacare's state health insurance exchanges. Or, you may qualify for free or low-cost coverage through Medicaid or the Children's Health Insurance Program, aka CHIP. How do I qualify for an Obamacare subsidy to cut health insurance costs? Beginning in 2014, if you earn between $11,500 and $46,000 per year for a single person or $23,550 and $94,200 for a family of four and do not have affordable employer-sponsored coverage, you could receive an "advance premium tax credit" to help with the cost of insurance purchased through your state's exchange, or marketplace. A premium discount is deducted from your federal income tax, and you decide how much to put toward your insurance payment each month. You also may qualify for help with out-of-pocket health care costs, if you earn less than $28,725 as a single person or $58,875 for a family of four. What is a state health insurance exchange, or marketplace? Obamacare requires each state and the District of Columbia to establish an easy-to-use online health insurance marketplace where individuals and small businesses can compare health plans and find coverage that fits their budget. The exchange also will tell you if you're eligible for a federal tax subsidy to help pay your premium or if you qualify for a government safety net program such as Medicaid. The inaugural open enrollment period for the new marketplaces runs from Oct. 1, 2013, to March 31, 2014, with plan coverage beginning Jan. 1, 2014. Who is exempt from paying the penalty for not having health insurance? The law excuses certain individuals from the penalty, including members of religious sects that have religious objections to health insurance, participants in health care sharing ministries, and those who are uninsured for less than three months of the year. You also could be exempt if your income is too low to require a federal tax return, you can't reasonably afford coverage, or you would have qualified for Medicaid had your state elected to expand the program as provided for under the Affordable Care Act. I've had the same policy for years. Does health care reform affect my plan? Some provisions of the Affordable Care Act do not apply to so-called grandfathered plans written before the law took effect. These include the freedom to choose your own doctor, preventive services at no additional cost, and the right to appeal if your insurer denies a claim. However, as with new policies, grandfathered plans are required to cover children up to age 26, provide a simple summary of coverage and costs, and cease any lifetime limits on benefits. How can I be sure that my current coverage will allow me to avoid the Affordable Care Act penalty? You're OK if you are currently insured through: an individual or group plan (grandfathered or not); a veterans health care program, including Tricare; Medicare; Medicaid; the Children's Health Insurance Program, or CHIP; Peace Corps volunteer plans; or COBRA continuation coverage for the unemployed. Does the Affordable Care Act affect my employer's group plan? Yes. For employer-based insurance, it means: preventive services at no additional cost (unless you have an older, grandfathered plan); an end to lifetime/annual dollar limits and cancellation of coverage if you get sick; guaranteed coverage for your adult children until age 26; guaranteed coverage if you have a pre-existing condition; and the right to appeal a denied claim. If your employer's plan costs more than 9.5% of your income or doesn't meet the law's minimum coverage requirements, you might qualify for subsidized coverage on your state health marketplace, or exchange. I've never shopped for health insurance before. How will the marketplace help? All private health insurance plans offered through the state marketplaces must offer the same set of "essential health benefits" as defined under the Affordable Care Act. These include: hospitalization; emergency care; rehabilitative services; lab tests; prescription drugs; preventive care; maternity, newborn and pediatric care; and treatment for mental health disorders and substance abuse. How can I tell Obamacare plans apart? To facilitate apples-to-apples comparison shopping, marketplace plans will be grouped into four "metal" categories, from less expensive bronze and silver coverage to the more expensive gold and platinum plans. If you're younger than 30 or have a very low income, the marketplaces also will offer high-deductible, lower-premium catastrophic coverage. I never shop online. Is it safe? The new state marketplaces are designed to be secure and password-protected. All health insurance policies offered through them have been approved by your state's department of insurance and certified by the marketplace. You'll need to fill out an online application; the site will determine if you qualify for premium discounts, reduced out-of-pocket costs, or coverage under Medicaid based on your income and family size. I'm on Medicare. Does the Affordable Care Act affect me? In many ways, no; Medicare officials have been stressing to seniors that their benefits are not fundamentally changing and that they will not need to use an online marketplace. But thanks to the Affordable Care Act, Medicare recipients now receive free preventive services, including a wide range of health screenings and an annual wellness visit. In 2012, those with Medicare Part D prescription drug coverage received a 50% discount on brand-name drugs and a 14% discount on generics. Those savings will increase through 2020 as the ACA slowly closes the so-called prescription drug doughnut hole. Some of my friends received rebate checks from their health insurers the past two summers. Why didn't I get one? One way the Affordable Care Act is attempting to rein in health costs is through the "80-20 rule." Health insurers must spend 80% of your insurance premium directly on your health care and no more than 20% on their administrative costs. (For employer group plans, at least 85% of premiums must go toward care.) Insurers that fail to meet the mark must issue rebates to each policyholder. If you buy your own health insurance and didn't get a rebate, it likely means your insurer passed the efficiency test.
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State exchanges under new health care law creating confusion for some Medicare recipients

(AARP/ Associated Press ) - In this image made available by AARP shows Wallace Cunningham, left, AARP South Carolina Associate State Director for Multicultural Outreach presenting a workshop on the Affordable Health Care Act on Saturday, Sept. 7, 2013 in Bishopville, S.C. Federal Health Officials are assuring medicare recipients that their benefits will not change when the Affordable Care Act starts. Many are confused by overlapping enrollment periods for Medicare and the Affordable Care Act.
MIAMI — Dear seniors, your Medicare benefits aren’t changing under the Affordable Care Act. That’s the message federal health officials are trying to get out to some older consumers confused by overlapping enrollment periods for Medicare and so-called “Obamacare.”
Medicare beneficiaries don’t have to do anything differently and will continue to go to Medicare.gov to sign up for plans. But advocates say many have been confused by a massive media blitz directing consumers to new online insurance exchanges set up as part of the federal health law. Many of the same insurance companies are offering coverage for Medicare and the exchanges.
Medicare open enrollment starts Oct. 15 and closes Dec. 7, while enrollment for the new state exchanges for people 65 and under launches Oct. 1 and runs through March.
“Most seniors are not at all informed. Most seniors worry they’re going to lose their health coverage because of the law,” said Dr. Chris Lillis, a primary care physician in Fredericksburg, Virginia. “I try to speak truth from the exam room but I think sometimes fear dominates.”
Next month, roughly 50 million Medicare beneficiaries will get a handbook in the mail with a prominent Q&A that stresses Medicare benefits aren’t changing. Federal health officials have also updated their training for Medicare counselors, and are prepping their Medicare call center and website.
“We want to reassure Medicare beneficiaries that they are already covered, their benefits aren’t changing, and the marketplace doesn’t require them to do anything different,” said Julie Bataille, spokeswoman for the Centers for Medicare and Medicaid Services.
But she said call centers for the state exchanges are already fielding questions from Medicare recipients and rerouting them to the Medicare line.
Bob Roza attended several meetings trying to figure out exactly what the Affordable Care Act means for him and his 69-year-old wife Gail, who has diabetes.
“At that time, I didn’t know if Medicare would be secondary to some Affordable Care Act option. It was just a myriad of concerns and not knowing,” said the 72-year-old Roza, a retiree who lives in Oakdale, Calif., and is recovering from hip replacement surgery earlier this year.
He now knows that his Medicare coverage won’t change, but says he’s now worried about the impact on the $614 a month he pays for Medicare supplemental insurance. Federal health officials said seniors will not be able to purchase Medicare supplemental insurance or Part D drug plans through the state exchanges.
Jodi Reid, executive director of the California Alliance for Retired Americans, worries there hasn’t been enough outreach to seniors and that advocacy groups are spending the bulk of their advertising funds targeting those impacted by the exchange. Her organization, which represents nearly 1 million seniors in California, is putting together a one-page fact sheet to help dispel myths.
“Nothing has been done that I have seen to deal with the 4.4 million people in California who are on Medicare who are not going to be impacted the same way as the rest of us so it’s causing a lot of confusion,” she said.
AARP officials said they anticipate a spike in calls after the October launch date for the new state exchanges. To help clarify everything for seniors, the organization is holding various events around the country, such as a senior day next month at the state fair in Columbia, S.C. Next month, the group is also hosting 21 telephone town halls, which will include hundreds of thousands of phone calls to seniors.
“Usually the marketing is just targeted to the Medicare beneficiary, this time it’s going to be spread out a little bit more. If they call the wrong places, we’re doing our very best to make sure they’re guided back to the correct place,” said Nicole Duritz, vice president of health education.
In Illinois, it’s not only seniors who are confused, but also the social workers who help them, said Erin Weir of AgeOptions, suburban Cook County’s lead agency on aging. The agency coordinates a statewide training program for groups that work with older adults.
During these trainings, Weir said, she’s repeatedly heard questions from social workers who think seniors will be able to sign up for Medicare programs on the new marketplace websites, even though they cannot.
“We’ve been focusing on people who are already on Medicare, calming them down and saying, ‘You don’t have to do anything, you’re fine,’” Weir said.
Advocates are also warning of scams that may pop up alongside legitimate door-to-door outreach about the Affordable Care Act ramps up and advising seniors not to give out personal information.
Senior groups are also devoting resources to educating the 50- to 65-year-old group who are next in line for Medicare, a segment that could be greatly affected by the health reform. Under the new law, insurers will have to offer more benefits in some cases and are restricted in how much they can charge older, sicker people. They’re also banned from turning away those with pre-existing conditions.
Anthony Wright, executive director of Health Access California, said many people nearing retirement age stand to benefit the most by the health care reform.
“They’re the ones most likely to have pre-existing conditions, most likely to be charged more because of their age and medical condition and very likely to be an early retiree,” he said.
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Health insurance sales hit the mall -- and Web

Theresa Pugh stopped at a store near Lord & Taylor after eating at the restaurant a few doors down.
She picked herself up a supplemental Medicare plan from the Horizon Connect store.
"There's so much going on with health care in our country right now, I needed to go with someone that I trusted," says Pugh, of Mount Laurel, N.J. "I just felt like I wasn't being sold a bill of goods."
Call it the retailization of health insurance.
Shopping center owners may not be courting them as they would Apple or trendy fashion brands, but health insurers are increasingly opening stores alongside far sexier retail tenants.
With few people buying health insurance on their own, insurers have long focused on retaining and attracting the companies that offer it to their employees. Now, however, the new health law known as the Affordable Care Act means most uninsured Americans are required to have insurance beginning March 31 or pay a penalty at tax time in 2015.
Insurers need to sign up as many healthy, younger people as they can to pay for all of the older, sick customers they will be taking on. The law prohibits insurers from denying people insurance because of pre-existing health problems and limits how much more they can charge older than younger people.
So, for the first time, insurers are fiercely competing to attract individual consumers and turning to traditional retail marketing techniques to do so, luring them into stores with special events and using splashy advertising. As any retailer knows, they have the greatest chance of converting shoppers to customers once they have them in their retail locations or on their sites.
"It will be a departure for a lot of these insurance companies," says Farzan Bharucha, health care strategist with consulting firm Kurt Salmon. "Some insurance companies have been more progressive at consumer-directed health plans than others and some have done more marketing."
The stores can be a place for insurance clients to meet face to face with company representatives to discuss claims and benefits, but they are now seen as a way for the newly consumer-focused insurers to draw the uninsured to the plans they are offering in state exchanges starting Oct. 1.
They're "a cross between banks and H&R Block," Bharucha says. "This is not a Neiman Marcus."
Other insurance activity at the shopping center:
•Blue Cross Blue Shield of North Carolina will open its third retail store Friday and plans to open four more by the end of the year. The company has also launched a "Ready, Set, Go" online and event marketing campaign to coincide with the law's implementation. "Our representatives are looking to inform (customers) of all their options," spokeswoman Ryan Vulcan says. "People are looking to get answers about coverage for today and for what's forthcoming."
•United Healthcare has more than 20 retail locations now in states including Missouri, Nevada and Texas. The first was opened in the Chinatown section of New York City 20 years ago and the most recent was in Los Angeles.
•Highmark Health Services, also a Blue Cross Blue Shield provider, has 10 retail outlets in Pennsylvania. Highmark opened its first two Highmark Direct stores in March 2009 and has been adding more as the implementation of the law neared. The company says the stores have had more than 230,000 visitors and thousands have purchased health insurance. Blue Cross Blue Shield affiliates also have stores in Florida.
•Jones Lang LaSalle, which leases and manages 245 shopping centers in the U.S., is working with three major insurers it won't name on a retail pilot program, says Executive Vice President Walter Wahlfeldt. When he asked the companies why they were interested in retail, Wahlfeldt says they told him, "The health care reform act — there's a lot of confusion for a lot of people."
"Baby boomers prefer to purchase differently than their parents," Wahlfeldt says. "They're not comfortable with people coming to their home and are more comfortable with retail settings."
Mark and Donna Tatulli and their three children had been without health insurance for a few weeks when Donna visited the Horizon store. Mark, a children's book author and syndicated cartoonist, quit his day job last month to focus on a book launch. Donna knew they were eligible to buy on her state's health exchange next month but didn't want to wait until the deadline for coverage.
"You worry about the catastrophic event that will just destroy your whole life," Donna Tatulli says.
Consumer advocates are worried the new stores will attract uninsured people who should be shopping on their state's health exchange, where they can compare all the plans offered for sale starting Oct. 1.
"You want them to compete," says Ron Pollack, executive director of the non-profit health care group Families USA. "If you're buying a TV or a car, you don't look at one brand of TV or one make of car."
Pugh's purchase wasn't exactly on impulse — she was about to turn 65 and become eligible for Medicare. Overwhelmed with all the offers she was getting from insurance companies, she wanted a real person to sort it all out.
Even if she could have saved money by shopping around, buying at the Horizon store was "worth it because of the comfort level," says Pugh.
Because most insurers sell other kinds of insurance, Bharucha says he expects insurers will start looking at "the "lifetime value of customer" and how to retain them and sell them other products, such as life insurance.
"Insurers haven't tried to follow them and go through the thought process, 'How do I keep this patient?'" he says.
With a location that's "a long stone's throw" from Best Buy and attached to a busy shopping mall, the Horizon Connect store is capitalizing on its location.
"Black Friday was one of our bigger days," Joe Albano, vice president of consumer and senior markets for Horizon Blue Cross Blue Shield of New Jersey says of the busy shopping day after Thanksgiving. "It's the curiosity of the pop-in. People are trying to figure out what we are."
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New York Regulator Sees Abuse Increasing Under New Insurance Rules

Benjamin Lawsky, New York's financial services overseer, seeks to raise insurers' asset reserves.
Several big life insurers are going to have to set aside a total of at least $4 billion because New York regulators believe they have been manipulating new rules meant to make sure they have adequate reserves to pay out claims.
The development stems from contentions by insurance companies that states’ regulations are forcing them to hold too much money in reserve. Many of them have engaged in secretive transactions to artificially bolster their balance sheets, often through shell companies in other states or countries. Regulators, who want to be sure companies have enough real liquid assets to pay all claims, have struggled to find a solution that all 50 states can agree on, and decided to test a new framework of rules.
On Friday, New York State plans to drop out of that agreement, according to a letter from Benjamin M. Lawsky, the financial services superintendent, to his fellow state insurance regulators. In the letter, which was reviewed by The New York Times, Mr. Lawsky said the test, which started in 2012, showed that the new framework did not work and was, in fact, making the “gamesmanship and abuses” in the industry even worse.
The move appears to be another attempt by Mr. Lawsky to address the much broader potential problem of the life insurance industry’s use of the secretive transactions. He has derided them as “financial alchemy” because they seem to create surplus assets out of thin air. In June, Mr. Lawsky called on other state insurance regulators to join him in blocking any more of these transactions. But other regulators said they wanted instead to keep pursuing a test of the new regulatory framework. The test covers a narrow segment of the life insurance business, but state regulators, through the National Association of Insurance Commissioners, are committed to extending the framework to all parts of the life insurance industry over the next few years.
But the new framework is “so loose as to be practically illusory,” Mr. Lawsky said in his letter. A sample of 16 insurers in the test were expected to increase their reserves by $10 billion, he said, but instead only $668 million was added. And that was at just five of the 16 companies; the others did not report any reserve increase at all and in fact seemed inclined to reduce their reserves by about $4 billion.
“This cannot possibly be the ‘compromise’ that we as insurance regulators had in mind,” he told the other commissioners in his letter.
Starting on Friday, New York will revert to its previous way of calculating reserves, at least for the type of life insurance being tested, requiring insurers that offer it to add a total of $4 billion to their reserves. Known as universal life with secondary guarantees, the insurance offers both death benefits and a cash value to policyholders. Because its design is highly flexible, it has for years been subject to questions about the amount of reserves that should back it. Leading companies that sell such insurance include Lincoln National, Genworth, Principal, John Hancock, U.S. Life and Sun Life. When asked about New York’s move, company officials said they could not comment because they still knew little about it.
It was not clear what portion of the $4 billion each company would have to come up with, or how much time they would have. The total amount could ultimately be higher if regulators in other states decide to join Mr. Lawsky. People briefed on his decision said they did not expect any of the affected insurers to stop doing business in New York State but said they might start charging more for this type of policy in the future.
Mr. Lawsky also said he wanted the other insurance regulators to reconsider their commitment to adopting the new framework in its entirety, given its performance on the current test. Adopting it at this point “represents a potent cocktail that puts policyholders and taxpayers at significant risk,” he said.
Companies have been arguing for years that state insurance regulations are too formulaic, forcing them to hold far more reserves than necessary. The proposed new framework, known as “principle-based reserving,” would free insurance actuaries from having to follow statutory requirements in their calculations, allowing them instead to use their own data and assumptions.
While regulators grappled with the reserve question and one another, a wave of transactions washed through the life insurance industry, sweeping billions of dollars’ worth of business offshore, where reserve requirements are different. The transactions, known as captive reinsurance, often involve the creation of  subsidiaries, known as captives, that then sell reinsurance to their parent companies, which removes billions of dollars of policy obligations from the parents’ books.
In recent years, some states have been promoting themselves as good places to set up captives, promising insurers an offshore-style regulatory environment without the need to go offshore.
The transactions allow insurers to do other things with their money besides locking it up to pay future claims. But as they have become widespread, concerns have grown that insurers are lowballing their reserves and adding a large amount of hidden leverage to the life insurance industry.
In August, Moody’s Investors Service estimated that captive reinsurance had artificially bolstered life insurers’ balance sheets by $324 billion. The estimate covered a much wider sector than the one being monitored by New York State and included transactions conducted throughout the life insurance industry, as well as long-term care and disability insurance. Its finding suggests that as much as 85 percent of the sector’s aggregate capital and surplus is being enhanced by reinsurance through affiliated companies. Moody’s noted that the transactions did vary, and that not all of them caused hidden capital shortfalls. Some insurers do not engage in them at all.
The National Association of Insurance Commissioners has reacted to Mr. Lawsky’s June proposal with concern, saying he appeared to be giving the federal government reasons to step into the realm of insurance regulation, something the states generally oppose. The Dodd-Frank financial overhaul law created a body called the Federal Insurance Office within the Treasury Department, which has been studying state insurance regulation and is supposed to report on how current practices could be improved. Its report is more than a year overdue, but at an association meeting in late August, some officials said the report was imminent.
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