Obamacare 2.0: Shaky like 1.0

Obamacare 2.0: Shaky like 1.0
By: David Nather
April 26, 2013 05:23 PM EDT
Obamacare fires are flaring up all over — in Hill hearings, in scary headlines about big rate hikes and in closed-door meetings of nervous Democrats.

The White House response: We’ll get to that.

President Barack Obama’s messaging gurus and their allies say they will step on the gas before enrollment begins this fall, but the effort, they concede, is not in full swing.

Obama’s allies know the health care law needs a massive outreach effort, but Obamacare Round 2 is already starting to look a lot like Round 1, when Democrats roundly accused the White House of botching its appeal to the public, giving Republicans the upper hand on defining the law.

It’s a clear contrast with the immigration reform effort, where the rollout has been filled with business and advocacy groups praising the Gang of Eight bill and quickly knocking down any attacks. This week, there has been plenty of fodder for GOP critics of the health care law but mostly silence from the administration.

Part of that is because the White House team is in flux. Tara McGuinness, who just joined the White House to run the messaging of the law, told POLITICO that her shop is “ramping up on the health care communications and outreach.”

She pointed out that Democratic senators met with White House chief of staff Denis McDonough on Thursday, the first in a series of Hill meetings.

Meanwhile, the groups that will be responsible for on-the-ground work say they’re waiting.

Obama is leaning heavily on outside allies, and on Friday he asked Planned Parenthood to help sell the law with a pitch heavy on benefits to women, like contraceptive coverage and preventive care — the same targeted themes he stressed during his reelection campaign.

(Also on POLITICO: Obama urges Planned Parenthood to help inform on Obamacare)

But Enroll America, the coalition of health care advocates, industry groups, and labor and civil rights organizations that’s planning a massive outreach effort, says it’s still planning to kick into full gear its “Get Covered America” campaign this summer — it’s not speeding up the timetable. Headed by Anne Filipic, the former deputy director of the White House Office of Public Engagement, the coalition is planning a campaign of online organizing, grass-roots outreach and paid advertising.

Organizing for Action has been planning its own outreach campaign for the summer, too, which is shaping up as a big test of the strength of its armies of volunteers. OFA officials didn’t respond to questions about whether they’ll speed up their plans.

Why wait? The answer, the law’s supporters say, is that if they do the outreach too early — and people are told they can sign up for Obamacare coverage with generous subsidies but there’s nowhere to go right now — they’ll just tune out.

But Democrats are worried now — about the messaging and the mechanics of the rollout.

“I’m concerned — because we did take substantial criticism for putting this plan in place — that it achieve its true purpose,” said Rep. Lloyd Doggett of Texas. “There’s so much work to do in such a short period of time.”

(Also on POLITICO: Obamacare exemption talk lights up Capitol Hill)

Other Democrats say the public is still confused about the law and they want to see more outreach and public education. Sen. Max Baucus, an author of the law, raised that concern in a recent hearing, arguing that if the administration doesn’t act, they’ll face a “huge train wreck coming down” — a comment that got serious attention from Republicans this week.

“I think there is a lot of confusion,” Rep. Diana DeGette of Colorado, a chief deputy whip for House Democrats and a vocal supporter of the law, told POLITICO. She’s not worried about Republican “hand-wringing” about all of the law’s potential problems, she said, “but what is of concern is that the October deadline … is rapidly approaching, and we need to make sure there is outreach happening.”

DeGette agreed that it may be too early to crank up the outreach machinery to full volume. Even though she’s planning town halls this summer to talk up the law and its benefits and said all members of Congress should do the same, “I think it would just cause more confusion if we did it right now because there’s no exchange for them to go to.”

But DeGette still says there’s an urgent need for more public education — at the right time.

She recalled a recent conversation where “a woman came up to me in Denver and said, ‘I’m a single mom, I make $40,000 a year. I don’t know how I’m going to get health insurance.’” When DeGette told her the Colorado health exchange would open on Oct. 1 and she might be eligible for coverage and subsidies, the woman reacted as if she’d never heard of Obamacare before: “She said, ‘I am? How do I get that information?’”

Other advocacy groups, like the National Council of La Raza and Young Invincibles, say they already have their own outreach efforts under way. “We certainly think it’s never too soon to start promoting the fact that big changes are coming,” said La Raza’s Jennifer Ng’andu.

Ron Pollack, executive director of Families USA, an advocacy group that’s leading the outreach effort, says the top priority should be for HHS to just keep working on the exchanges and the other infrastructure that will be needed for the October launch.

“I have every reason to be confident that the train is on track and will arrive at the station on time,” Pollack said. “Will there be any glitches? Of course, … and as problems emerge, as they do with every new program, they will be fixed.”

But as Democrats are realizing, those glitches gives the Republicans plenty of room to jump on every hint of a problem with Obamacare — and that’s exactly what they’ve been doing.

Senate Minority Leader Mitch McConnell had fun with Baucus’s “train wreck” comment by suggesting that Obama should give a speech warning about how terrible the law will be, and other Republicans have been circulating the “train wreck” quote all week.

And Republicans got new ammunition for their warnings that Obamacare will cause big health insurance premium hikes after CareFirst BlueCross BlueShield proposed a 25 percent rate hike for its coverage of individuals — and said it’s because of the law. Maryland officials have insisted, however, that those rates aren’t final and the state’s insurance commissioner can reject them — a point HHS Secretary Kathleen Sebelius also made to lawmakers on Thursday.

Chet Burrell, CareFirst’s president and CEO, says the nonprofit insurer will have to raise its rates that much because of the law’s requirement that everyone will have to be accepted for coverage next year, even if they have pre-existing conditions. He’s not opposed to that goal — he calls it a “very worthy public purpose” — but says it will make individual coverage more expensive.

Everyone who is in Maryland’s high-risk pool now — a program specifically designed to cover people with pre-existing conditions — will switch to regular private coverage, Burrell said, and health coverage for those people is five times as expensive as it is for everyone else with individual coverage.

“This isn’t some evil health insurance company plot,” Burrell said, but a “realistic” look at what happens when everyone with pre-existing conditions can get regular health coverage for the first time.

Advocates aren’t too worried about the danger that other insurers across the country could boost their rates in the same way. Pollack said CareFirst, which provides coverage to his group, already had a history of asking for big rate increases even before the law.

Jen Mishory of Young Invincibles, which is trying to get young adults to sign up for Obamacare, notes that those aren’t the actual rates most people would pay — most young adults would get subsidies that would hide a lot of the cost. And if other insurers in the health exchanges offer lower rates, “the consumers will be able to choose” based on those prices, she said.

But Burrell predicts that other insurers will ask for the same kinds of rate increases when they sell their individual plans in the health exchange, and he says the only reason other Maryland insurers haven’t been called out on it is that their filings with the state have been so confusing that it’s hard to tell what their actual increases will be.

Members of Congress, meanwhile, had a big headache on their hands after POLITICO reported on efforts to fix a part of the law that requires lawmakers and their staffs to get their coverage through the health exchanges instead of through the same federal employees health plan that covers other government workers.

The problem is that the provision — added to the law by Republican Sen. Chuck Grassley of Iowa — isn’t clear on how they’d get their employer contributions that pays for most of their premiums now through the Federal Employees Health Benefits Program. The measure was supposed to be a statement that Congress should be treated like everyone else, but if they don’t find a fix, they could end up paying the entire premium themselves — which is harsher than how others in the exchanges would be treated.

Now, Democratic leaders are fighting Republican charges — fueled by the POLITICO coverage — that they’re trying to get special treatment for Congress, but they insist they’re just trying to make sure that there’s a way to pay for the premiums and treat all staff members equally (some fall under the provision, some don’t). House Minority Leader Nancy Pelosi is pushing for an administrative fix that wouldn’t require new legislation.

There are various scenarios about how that could happen, but the focus is on preventing them from having to pay the full cost of insurance themselves — unlike other people who will be in the exchanges or who get covered on the job.

But the whole episode shows how lawmakers are now facing the consequences of the way the health care bill was passed — by taking the Senate bill and passing it in the House, without the chance to work out a final bill in a House-Senate conference committee that would have cleaned up the sloppy language.

“It’s, frankly, grossly inadequate,” DeGette said. “It’s one of those Senate specials where they put it into the bill to get votes and then it never went to conference, so it never got fixed.”

Jennifer Haberkorn contributed to this report.

This article first appeared on POLITICO Pro at 5:17 p.m. on April 26, 2013.

Democratic Senators Tell White House of Concerns About Health Care Law Rollout

April 25, 2013

Democratic Senators Tell White House of Concerns About Health Care Law Rollout

By ROBERT PEAR, NY Times

WASHINGTON — Democratic senators, at a caucus meeting with White House officials, expressed concerns on Thursday about how the Obama administration was carrying out the health care law they adopted three years ago.

Democrats in both houses of Congress said some members of their party were getting nervous that they could pay a political price if the rollout of the law was messy or if premiums went up significantly.

President Obama’s new chief of staff, Denis R. McDonough, fielded questions on the issue for more than an hour at a lunch with Democratic senators.

Senator Jeanne Shaheen, Democrat of New Hampshire, who is up for re-election next year, said, “We are hearing from a lot of small businesses in New Hampshire that do not know how to comply with the law.”

In addition, Mrs. Shaheen said, “restaurants that employ people for about 30 hours a week are trying to figure out whether it would be in their interest to reduce the hours” of those workers, so the restaurants could avoid the law’s requirement to offer health coverage to full-time employees.

The White House officials “acknowledged that these are real concerns, and that we’ve got to do more to address them,” Mrs. Shaheen said.

Senator Tom Harkin, Democrat of Iowa and chairman of the appropriations subcommittee on health care, said he was extremely upset with Mr. Obama’s decision to take money from public health prevention programs and use it to publicize the new law, which creates insurance marketplaces in every state.

“I am greatly disappointed — beyond upset — that the administration chose to help pay for the Affordable Care Act in fiscal year 2013 by raiding the Public Health and Prevention Fund,” Mr. Harkin said.

The administration said it had transferred $332 million from the prevention fund to pay for “education and outreach” activities publicizing the new insurance markets, or exchanges.

To express his displeasure, Mr. Harkin has blocked Senate action on Mr. Obama’s nominee to be administrator of the Centers for Medicare and Medicaid Services, Marilyn B. Tavenner. By putting a “hold” on the nomination, aides said, Mr. Harkin hopes to draw the White House into negotiations on the future of the prevention fund, which he has championed.

At Congressional hearings this week, Kathleen Sebelius, the secretary of health and human services, said it was necessary to tap the prevention fund because Congress had refused to provide money requested by the president for outreach and education activities.

Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, said last week that the administration deserved “a failing grade” for its efforts to explain the law to the public.

“I just see a huge train wreck coming down,” Mr. Baucus said then.

But after hearing White House officials on Thursday, Mr. Baucus said he was encouraged, and he praised the administration’s efforts to get healthy young people to sign up for insurance coverage.

Senator Benjamin L. Cardin, Democrat of Maryland, said he told White House officials on Thursday that he was concerned about big rate increases being sought by the largest health insurer in his state. The company, CareFirst BlueCross BlueShield, has sought increases averaging 25 percent for individual insurance policies that will be sold in the state insurance exchange, and it is seeking increases of about 15 percent for small businesses. The company said the higher premiums reflected costs of complying with the new law.

Senator Cardin said he was also distressed by the administration’s failure to require health insurers to provide affordable coverage of dental services for children. The law lists pediatric dental care as one of 10 categories of “essential health benefits” to be provided by all health plans.

Under a rule issued by the administration, Mr. Cardin said, “there is no guarantee or requirement that families have pediatric dental coverage, and the coverage could be provided in a stand-alone plan with a separate deductible, so that a family with two children might have to pay as much as $1,400 in out-of-pocket costs for dental coverage.”

In that case, he said, many families would go without dental coverage.

Congressional leaders wrestled at the same time with a more parochial concern, health insurance for members of Congress and their aides.

A provision of the 2010 law, sought by a Republican senator, says members of Congress and many of their aides must get their health benefits through the new insurance exchanges. Some lawmakers and their aides are worried that the government may not continue to pay its share of the premiums.

Michael Steel, a spokesman for Speaker John A. Boehner, said this was the “Democrats’ problem to solve.”

But Adam Jentleson, a spokesman for Senator Harry Reid of Nevada, the Senate Democratic leader, said, “No legislative fix is necessary.”

With health law looming, one large insurer wants a 25 percent premium hike

Sebelius Aims to Set Record Straight on Small Business Exchanges

CQ HEALTHBEAT NEWS
April 17, 2013 – 5:16 p.m.

Sebelius Aims to Set Record Straight on Small Business Exchanges

By John Reichard, CQ HealthBeat Editor

Among the groups most confused about the health care law are small businesses — a charge Chairman Max Baucus leveled at a Senate Finance Committee hearing Wednesday.

But Health and Human Services Secretary Kathleen Sebelius sought to clear away at least one area of confusion: what choices will be offered to small businesses and when the new insurance marketplaces — called SHOP exchanges — will be available. The short answer: They’ll have a choice in every state starting next year.

The Montana Democrat said that in his home state, “people are worried about the impacts of new rules and how the marketplaces will affect their families and small businesses. He said that a staffer with the Montana Center for Rural Affairs has been traveling across the state to talk to business groups and consumers. She says there are few attendees at the informational meetings. People who do show up often express a lack of understanding about the marketplaces and what they offer.

“My real concern is more with the business perspective more than it is with the consumers,” Baucus told Sebelius, who was on hand to testify about the administration’s fiscal 2014 budget proposal.

But when Baucus raised the issue of a delay associated with the SHOP exchanges — the term under the law (PL 111-148, PL 111-152) for the marketplaces for small business — Sebelius said, “that’s not correct.”

Small businesses will all have a choice of plans in SHOP exchanges and they will open in every state in January, she said. But in states served by the federal exchange, the employees of small businesses as distinct from their owners would not have a choice before 2015, she said, and then only if the owner of the business decides to give them a choice.

Republicans have criticized this delay in giving employees a choice of plans, which the administration attributes to requests from the insurance industry and the complexity of setting up premium payment mechanisms when the employees of one small business are allowed to enroll in a number of plans.

Sebelius said, however, that in those states that aren’t served by the federal exchange — 17 aim to set up their own marketplaces — employees of small businesses in some instances may have a choice of plans in year one. The delay relates only to SHOP exchanges associated with the federal exchange, she emphasized.

“So in 2014 all employers will have a choice,” she said. “They’ll have a choice of plans to offer their employees. They just will not be able to say to that employee should they choose to do so ‘you can choose any plan in the SHOP market.’”

But Baucus, who said the administration “deserves a failing grade” for educating the public about the health law, told Sebelius: “I’ll be watching.”

Source: CQ Online News

City Paper: D.C. Set to Sue Construction Firms Over Alleged Fraud

D.C. Set to Sue Construction Firms Over Alleged Fraud

Posted by Alan Suderman on Apr. 16, 2013 at 9:17 pm

City sources tell LL that District Attorney General Irv Nathan‘s office is set to file a lawsuit soon—possibly Wednesday—against two construction firms that teamed up to manage construction of Anacostia High School.

The lawsuit will allege that Rockville, Md.-based Forrester Construction and nominally D.C.-based EEC of D.C. conspired to defraud the District government through a phony joint venture that benefited from the city’s beleaguered contracting set-aside effort known as the Certified Business Enterprise program.

The lawsuit filed by the city will be a civil lawsuit filed under the Racketeer Influenced and Corrupt Organizations Act, or RICO, the sources say. It will allege that the two companies conspired to commit fraud, according to the sources. One source, who was not authorized to speak on the record, says the allegations in the civil case could form the foundation for a future criminal case. Calls to both firms were not immediately returned Tuesday evening.

LL has written extensively about CBE-related problems at the $62 million Anacostia renovation project. EEC of D.C. is a certified as a local CBE and enjoys preference points when bidding on city contracts, making it easier for the company to win bids than it would be for a non-certified competitor. Those preference points were extended to a joint venture between EEC of D.C. and Forrester when they bid on the Anacostia job, with the proviso that EEC of D.C. would control at least 51 percent of the venture. But as part of a civil court case last year between the two firms, EEC of D.C. filed contracts that showed that Forrester controlled about 95 percent of the project, instead of 49 percent. EEC of D.C.’s owner, Andre Downey, also alleged that Forrester did the same thing on other city projects, including subcontracting 100 percent of the work to itself on a senior center in Ward 1, and kept more than $47 million worth of work for itself on the $48 million construction of the new Department of Employment Services headquarters on Minnesota Avenue NE. In total, Forrester and EEC of D.C. partnered for more than $100 million worth of city construction projects.

The lawsuit will mark the first time in recent memory that the city has gone after contractors officials believe have abused the CBE program. Forrester is a well-known, mid-sized firm that does work around the region as well as with the federal government. On its website, the company has a picture of President Barack Obama and former President Bill Clinton taking a tour of a Forrester-managed project of an office building near the White House at 815 Connecticut Ave. NW. The company is active around the city, and is currently part of a joint-venture building a new $40 million student center at the University of the District of Columbia.

Forrester officials have declined to discuss Downey’s allegations with LL or during a public D.C. Council hearing that was held following LL’s articles on the problems at Anacostia.

The lawsuit could reflect poorly on the stewardship of City Administrator Allen Lew and Department of General Services Director Brian Hanlon of the city’s multi-billion dollar school construction effort. Lew was in charge of school construction when the Anacostia project got started, and Hanlon had taken over for Lew by the project’s completion.

Emails obtained through a Freedom of Information Act request show not only did city officials first ignore potential warning signs of a fraudulent CBE-certified joint venture, but one official later suggested trying to quiet the problem with a $250,000 payment using public money.

The emails show that Hanlon and the private contractors Lew has installed at DGS to oversee public construction projects initially ignored Downey in late 2011 when he alleged to city officials that the joint venture was a sham.

“Being that this is a dispute between the contractor and their sub, there isn’t much we can do,” wrote Will Mangrum, a private contractor who oversees school construction for DGS, in an email that was copied to Hanlon and other DGS officials on Nov. 12, 2011. Last September, Hanlon told LL that he never received a letter from Downey outlining his allegations, a claim the emails obtained through FOIA suggest is inaccurate. A month after Downey tried to alert city officials to the potential fraud, DGS awarded Forrester a new $6.8 million contract.

Last May, Thomas Bridenbaugh, a private attorney who handles the legal side of DGS’ construction contracting, wrote to Hanlon saying that he was working on finding a settlement between EEC of D.C. and Forrester, who were in a dispute over money. Hanlon wrote that the settlement he "floated" would have cost the District an additional $250,000 for the Anacostia project. It appears that Bridenbaugh’s suggestion never gained traction; both he and Hanlon have declined multiple requests for comment.

In June, an aide to Hanlon warned that DGS “may be asked what actions have been taken … to punish this admittedly fraudulent behavior.” But Hanlon did not refer the matter to the OAG until several months later, either in late September or early October of last year.

Lew said he wanted to punish both companies by prohibiting them from forming joint ventures for two or three years. The details of the forthcoming lawsuit from the attorney general aren’t immediately available, but it’s a fair guess that the city’s going after a much stronger punishment.

Keep in mind that the mess at Anacostia wasn’t just limited to its general contractors, either. Other questionable activity at the Anacostia project includes a mysterious $2.4 million payment to general contracting company owned by Keith Lomax, former Mayor Adrian Fenty‘s driver, for drywall work Lomax’s company did not perform.

Mayor Vince Gray says he’s committed to reforming the broken CBE program, but says he’s frustrated by the slow pace of reform. He recently asked 17 business leaders to form an advisory panel to help him craft new legislation aimed at improving the program. Among those named to the panel: the principals at two firms that oversaw the Anacostia project.

Aetna Markets ‘Off-Cycle’ Renewals to Extend Current Plans, Delay Full ACA Hit

Featured Health Business Daily Story, April 16, 2013

Aetna Markets ‘Off-Cycle’ Renewals to Extend Current Plans, Delay Full ACA Hit

Reprinted from HEALTH PLAN WEEK

By Patrick Connole, Editor – April 8, 2013 – Volume 23 Issue 12

In marketing materials for brokers and agents obtained by HPW, Aetna Inc. spells out options under its Premium Savings Program that could allow small-group employers to avoid the full impact of the Affordable Care Act (ACA) well past the Jan. 1, 2014, date that many provisions kick in. By employing “off-cycle” renewals, which are allowed under the ACA, a policyholder can extend a current plan for nearly all of next year and possibly avoid the 30% to 40% or more premium spike many predict when the provisions take effect.

Critics say plans using this loophole permitting current coverage to remain in place until the plan year expires could help distort risk pools in new exchanges starting operations in 2014. But other industry observers view the Aetna offer — and those expected from competitors — as a marketing tool to retain current members and win new ones before the full brunt of the ACA hits. These provisions include plans having to meet all of the requirements of the essential health benefits rules, limiting plan deductible amounts and strategizing around the new 3:1 age-rating bands in the ACA.

Such Aetna customers would not be “grandfathered” under the terms of the ACA. Grandfathered policies that were in place before the ACA was enacted in 2010 are not required to meet all of the law’s mandates as long as insurers or employers don’t make significant changes to the terms and conditions of the plans.

“They are playing games, is what it is. In a normal year they would never do this. Some smart lawyer found a loophole,” Sabrina Corlette, J.D., research professor at the Georgetown University Center on Health Insurance Reforms, tells HPW. By delaying the impact of the reform law, these policies, if extended into 2014 for younger, healthier people, could result in a less healthy risk pool for exchanges. But, as Corlette says, this would allow only a one-year delay, and “plans will have to come online with the ACA the following policy year.”

The three-page note from Aetna says early renewal options, which one market source likened to a magazine asking subscribers to lock in current rates for another year, are “one way that we can help provide cost savings to some of your clients during this time of change.”

New mandates taking effect in 2014 “will mean that some individuals and small businesses will pay more for their health coverage, and others less, depending on their unique factors,” Aetna spokesperson Stephanie Ancillai tells HPW. “The new ACA requirements also will mean some health benefit plans that customers have selected previously will not be available to them in 2014. Individuals and small businesses may have the option to keep the plan they have, which can help save premiums and avoid disruption.”

Plan Details Early Renewal Option for 2014

Aetna warned in the marketing materials that dramatic increases in premiums may be in the offing. “Factors such as essential health benefits, maximum plan deductibles, the application of new taxes and fees and new rating rules will combine to push insurance premiums up substantially for some small businesses. The rate impact can vary,” the insurer said. In December, Aetna CEO Mark Bertolini said he expects that premiums for individuals or small groups seeking coverage on health insurance exchanges will be in the neighborhood of 20% to 50% higher in 2014.

Aetna’s proposed solution is to alter typical renewal dates. “By electing a fourth-quarter 2013 renewal, some of your clients can achieve significant cost savings in 2014 and take time to assess their business needs for the future,” Aetna said. Among the options offered to clients is an off-cycle renewal between Sept. 1 and Dec. 1, 2013, keeping current benefits and rate levels in place for the following 12 months. Another option is to maintain the current renewal cycle in 2014 and move to the ACA-based plans. The insurer also noted that some accounts “may benefit by moving to Aetna due to competitive rates that remain constant from July 2013 through December 2014.”

Aetna’s marketing materials did not provide estimates of cost savings, and the company declines to provide further details on the program.

The materials point out that advance notice is required for groups interested in the Premium Savings Program. “Groups with a current Jan.-June renewal need to request an off-cycle renewal 90 days prior to the requested effective date, with acceptance needed 45 days prior to [the] new renewable date,” the insurer said. Aetna also asked brokers and agents to mark their calendars for a series of webinars on the savings program in April.

UnitedHealth Group and Cigna Corp. did not respond to queries from HPW on whether they too are offering programs similar to Aetna’s.

Robert Laszewski, president of Health Policy and Strategy Associates, LLC, tells HPW there is a business case for plans using every means at their disposal to help keep clients happy, including via early renewals. “The bottom line here is that everyone is expecting rate shock and looking for ways to smooth the transition for as many customers as possible. This can buy up to a year for small employers and individuals, and perhaps give everyone a year to figure out how we are going to deal with the much higher rates that are coming,” he says. “Some people say the insurers are about to ‘game’ the system. Tell that to the existing policyholders that are about to get slammed with huge rate increases.”

But Henry Aaron, the Bruce and Virginia MacLaury senior fellow at The Brookings Institution, tells HPW the real issue is what happens when the insurance plan expires since “the ACA is intended to be around indefinitely.” It is not as important, he says, that some small groups will see a delay in experiencing the full effect of the health reform law.

Tim Jost, a Washington and Lee University law professor and consumer representative for the National Association of Insurance Commissioners (NAIC), tells HPW the so-called loophole has been in the reform law the whole time, allowing for an effective date phase-in for policies that don’t have an end-date of Dec. 31, 2013. Some provisions of the ACA will be in force no matter the “mini-grandfathering” that may occur, he says. “For instance, reinsurance provisions apply to all plans on Jan. 1,” Jost adds.

Some states have taken steps to curtail the off-cycle renewals into 2014. The Los Angeles Times on April 2 quoted Oregon Insurance Commissioner Louis Savage as saying such renewals could be problematic, leading his office to bar any extension beyond March 31, 2014. “We want to get as many people as possible into the exchange,” Savage told the newspaper. “I think having renewals go deep into 2014 is counterproductive to the goals of the federal healthcare law.”

Poll: Anita Bonds has lead in D.C. Council race