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-(159/X 0

itso. PROCESSIN DIVISION HEE AUG 5 2010

PUBLICATION & REGULATIONS
BRANCH..

[As of: August 05, 2010

PUBLIC Status: Posted,

SUBMISSION racking No. BObsea11.
Comments Due: August 16, 2010}

Submission Type: Web

Docket: IRS-2010-0010
Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered
Health Plan Under the Patient Protection and Afforable Care Act

Comment On: IRS-2010-0010-0001
Group Health Plans and Health Insurance Coverage: Interim Final Rules for Relating to Status as
a Grandfathered Health Plan under the Patient Protection and Affordable Care Act

Document: IRS-2010-0010-0015
Comment on FR Doc # 2010-14488

Submitter Information

Name: BRUCE A WYLIE
Address:
200 E, McCARTY, SUITE 201
JEFFERSON CITY, 65101
Email: brucewylie@acecmo.org
Phone: 573-634-4080
Fax: 573-634-8929
Submitter's Representative: BRUCE A WYLIE
Organization: ACEC Missouri

General Comment

We are greatly concerned that the grandfather provisions outlined in the Interim Final Rules are
too restrictive and will cause many tax-exempt organizations to lose the grandfathering they
expected. If forced to consider options of a non-grandfathered plan before they have the benefit
of an Exchange, we are concerned that they may be priced out of the market and may even have
to drop coverage - something they do not want to do and a bizarre result given the intent of
health care reform.

Because many tax-exempt organizations are small in terms of total numbers of employees, and
because they generally cannot self-insure, they are often at the mercy of health insurance plans
sold by private carriers. These employers do not have control over copays and cost sharing. As
such, simple changes to plans beyond the control of these employers can cause their plans to
lose grandfather status. And since the Exchange is not currently in place, we anticipate that the
prospect of finding new affordable insurance that meets the new requirements of the Patient
Protection and Affordable Care Act is problematic at best. Further, in order to control costs so
that health insurance can be purchased for employees, these organizations often need to work
with their current insurance carriers to adjust copays and cost sharing to the extent they can in
order to afford coverage, especially in the current economic environment.

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We are concerned that Interim Final Rules as currently drafted may force some organizations to
make the difficult and undesirable choice of canceling health care coverage if grandfather status
is revoked, especially before the Exchange is in place. This is a very real concern, and in recent
years significant modifications and cancellations have occurred due to rising health care costs.

We would suggest for the transition period before the Exchange is established, that small and
medium sized employers be allowed to make cost saving changes to copayments and cost
sharing provided they do not reduce the per-employee amount they pay for insurance. This could
help these organizations adjust and preserve coverage in anticipation of greater reform and
options that will occur beginning in 2014. We also suggest that small and medium sized
employers be allowed to change insurance carriers prior to 2014 and have their plans treated as
grandfathers plans provided that provided they do not reduce the per-employee amount they pay
for insurance. This would allow them to maintain the level of coverage for employees, but reap
the benefit of a less expensive plan prior to the implementation of the Exchange.

https://fdms.erulemaking.net/fdms-web-agency/component/submitterInfoCoverPage?Call=P... 8/5/2010