ACA Now

Statutory Text

SEC. 1254. STUDY OF LARGE GROUP MARKET.
[Section 1254 added by section 10103(f)(2)]
(a) IN GENERAL.—The Secretary of Health and Human Services
shall conduct a study of the fully-insured and self-insured
group health plan markets to—
(1) compare the characteristics of employers (including industry,
size, and other characteristics as determined appropriate
by the Secretary), health plan benefits, financial solvency,
capital reserve levels, and the risks of becoming insolvent;
and
(2) determine the extent to which new insurance market
reforms are likely to cause adverse selection in the large group
market or to encourage small and midsize employers to self-insure.
(b) COLLECTION OF INFORMATION.—In conducting the study
under subsection (a), the Secretary, in coordination with the Secretary
of Labor, shall collect information and analyze—
(1) the extent to which self-insured group health plans can
offer less costly coverage and, if so, whether lower costs are
due to more efficient plan administration and lower overhead
or to the denial of claims and the offering very limited benefit
packages;
(2) claim denial rates, plan benefit fluctuations (to evaluate
the extent that plans scale back health benefits during economic
downturns), and the impact of the limited recourse options
on consumers; and
(3) any potential conflict of interest as it relates to the
health care needs of self-insured enrollees and self-insured employer’s
financial contribution or profit margin, and the impact
of such conflict on administration of the health plan.
(c) REPORT.—Not later than 1 year after the date of enactment
of this Act, the Secretary shall submit to the appropriate committees
of Congress a report concerning the results of the study conducted
under subsection (a).