Mark Lutes, a Member of the Firm in the Health Care and Life Sciences practice and serves as a Vice Chair of the firm’s Board of Directors, was quoted in an article titled “5 Trouble Spots You Could Face in Implementing the ACA.”
Following is an excerpt:
Ask people “What’s the most incomprehensible thing you’ve ever read?” and you’ll get a lot of different answers. Finnegan’s Wake. Your bundled phone-and-cable bill. Anything by Eckhart Tolle. Craig Garner, a Santa Monica, Calif.-based lawyer and health care consultant, has a favorite: “It’s 907 pages long, with 70,000 pages of regulations — and it’s not done!” That would be Public?Law 111—148, aka the Patient Protection ?and Affordable Care Act.
The ACA inches toward cost containment through Medicare payment reforms, and the Centers for Medicare & Medicaid Services hopes the commercial market will follow its lead. Medical loss ratios present a barrier, however, says Mark Lutes, a lawyer in the health care and life sciences practice at Epstein Becker Green, in Washington. “Designing payment reforms involves administrative costs, which plans have to watch.”
Competitive balance is a multifaceted concern. Regulating the small-group market “creates a less attractive market to insure from the payer’s perspective,” says Lutes at Epstein Becker Green, a national law firm. “Therefore, you’ll have everyone gravitating toward self-funding as far down as possible. That changes the ability to create a small group marketplace balance between exchange and non-exchange products.”