Linda Tiano Quoted in “Possibility of a ‘Copper’ Metal Tier for Exchanges Challenges ACA Coverage Goals”

Health Plan Week

Linda Tiano, a Member of the Firm in the Health Care and Life Sciences practice, in the Washington, DC, and New York offices, was quoted in an article titled "Possibility of a 'Copper' Metal Tier for Exchanges Challenges ACA Coverage Goals."

Following is an excerpt:

Proposed legislation to create a public exchange metal tier category for low premium "copper" policies flies in the face of the Affordable Care Act (ACA) goal to adequately cover more Americans, and it may also defeat the hopes of health insurers banking on younger, healthier lives enrolling in the exchange risk pool, market consultants say. ?...

Insurance industry observers say there are sizable risks for both consumers and insurers if copper plans come to be. They also stress that what sparked the proposal's emergence is the political pressure on lawmakers who backed the ACA and are running for re-election in states that have a strong mix of Republicans and Democrats — as in the cases of Begich and Warner. ?...

There is also the concern that at some point, any attempt to go below the bronze level would be counterproductive to what the industry saw as acceptable insurance coverage long before the reform law appeared. "Before the ACA, the states all had policies regarding what was illusory coverage," Linda Tiano. "And you couldn't offer a policy that had 50% [actuarial value]?...and in New York nothing below 70%. So right now it's down to 60% for bronze and if you go down to 50% or 40% actuarial value, is that really insurance coverage?" ?...

Tiano agrees that there is inherent risk for insurers with copper. "I would think from an insurer's perspective there is the fear to the extent you get policies like that, with the coverage so de minimus that it starts to push the healthier people toward those policies and the sicker people toward the higher-coverage policies. There is always concern about whether those types of policies will really instigate shifting of risk into certain pools in a way that makes those pools very expensive," she says.