HJAR Nov/Dec 2023

HOSPICE RATINGS 32 NOV / DEC 2023 I  HEALTHCARE JOURNAL OF ARKANSAS   complained bitterly that insurers are requir- ing them to get approval in advance for an increasing array of services, causing delays and, in some instances, harm. The govern- ment, however, hasn’t compelled insurers to reveal how many requests for prior autho- rization they get or what percent they deny. These and other specifics — particularly about which procedures and treatments insurers reject most — would be necessary to turn the government’s data into a viable tool to help consumers choose health plans, said Eric Ellsworth, the director of health data strategy at Consumers’ Checkbook, which designs such tools. A spokesperson for CMS said that, start- ing in plan year 2024, the agency will require insurers offering federal marketplace plans to submit a fewmore numbers, including on out-of-network claims, but there’s no time- line yet for much of what advocates say is necessary. Another effort, launched by a different set of federal regulators, illustrates the resis- tance that government officials encounter when they consider demanding more. The U.S. Department of Labor regulates upwards of 2 million health plans, includ- ing many in which employers pay directly for workers’ health care coverage rather than buying it from insurance companies. Roughly two-thirds of American work- ers with insurance depend on such plans, according to KFF. In July 2016, an arm of the Labor Department proposed rules requir- ing these plans to reveal a laundry list of never-before-disclosed information, includ- ing how many claims they turned down. In addition, the agency said it was consid- ering whether to demand the dollar amount of what the denied care cost, as well as a breakdown of the reasons why plans turned down claims or denied behavioral health services. The disclosures were necessary to “rem- edy the current failure to collect data about a large sector of the health plan market,” as well as to satisfy mandates in theAffordable Care Act and provide critical information for agency oversight, a Labor Department factsheet said. Trade groups for employers, including retailers and the construction industry, immediately pushed back. The U.S. Chamber of Commerce said complying with the proposal would take an amount of work not justified by “the lim- ited gains in transparency and enforcement ability.”The powerful business group made it sound like having to make the disclo- sures could spark insurance Armageddon: Employers might cut back benefits or “elim- inate health and welfare benefits altogether.” Trade groups for health insurance com- panies, which often act as administrators for employers that pay directly for work- ers’health care, joined with business groups to blast the proposal. The Blue Cross Blue ShieldAssociation called the mandated dis- closures “burdensome and expensive.”AHIP questioned whether the Labor Department had the legal authority to collect the data and urged the agency to withdraw the idea “in its entirety.” The proposal also drew opposition from another, less expected quarter: unions. Under some collective bargaining agree- ments, unions co-sponsor members’health plans and would have been on the hook for the new reporting requirements, too. The AFL-CIO argued the requirements created a higher standard of disclosure for plans overseen by the Labor Department. To be fair and avoid confusion, the group said, the Labor Department should put its rules on ice until federal health regulators adopted equivalent ones for plans this proposal didn’t cover. That left the transparency push without political champions on the left or the right, former Assistant Secretary of Labor Phyllis Borzi, who ran the part of the agency that tried to compel more disclosure, said in a recent interview. “When you’re up against a united front from the industry, the business community and labor, it’s really hard to make a differ- ence,” she said. By the time the Labor Department stopped accepting feedback, Donald Trump had been elected president. One trade association for large employ- ers pointed out that theAffordable CareAct, which partly drove the new rules, was “a law that the incoming Administration and the incoming leadership of the 115th Congress have vowed to repeal, delay, dismantle, and otherwise not enforce.” The law managed to survive the Trump administration, but the Labor Department’s