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DIVISION
GAL PROCESSING Aug

PUBLICATION & REGULATIONS fp ECHSUR LC 5 2010

[As of: August 05, 2010

PUBLIC Status: Posted,

Posted: August OS uae
SUBMISSION 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-2010-0010-0030
Comment on FR Doc # 2010-14488

Submitter Information

Name: Keith R. Orloff
Address:
6 West Dry Creek Circle
Suite 110
Littleton, CO, 80120
Email: keith. orloff@arcstsa.org
Phone: 303-694-9262
Fax: 303-741-3655
Submitter's Representative: Keith Orloff
Organization: Accreditation Review Council on Education in Surgical Technology and Surgical

Assisting
—

General Comment

See attached file(s)

Attachments

IRS-2010-0010-0030.1: Comment on FR Doc # 2010-14488

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


August 4, 2010

Office of Consumer Information and Insurance Oversight
Department of Health and Human Services

Room 445-G Hubert H. Humphrey Building

200 Independence Ave. SW

Washington, DC 20201

Re: OCIIO-991-IFC, The Interim Final Rules for Group Health Plans and Health Insurance
Coverage Relating to Status as a Grandfathered Health Plan Under the Patient Protection and
Affordable Care Act

On behalf of the Accreditation Review Council on Education in Surgical Technology and Surgical
Assisting (www.arestsa.org), we appreciate the opportunity to comment on the Interim Final Rules
regarding grandfathered health plans under the Patient Protection and Affordable Care Act. ARC/STSA
is a section 501(c)(3) non-profit accrediting organization serving more than 460 allied health discipline
higher education programs in both surgical technology and surgical assisting in the United States. The
ARC/STSA works in collaboration with the Commission on Accreditation of Allied Health Education
Programs (CAAHEP) as one of its 18 designated Committees on Accreditation (CoA) to set national
standards and determine accreditation eligibility and status for colleges, universities and other institutions.

We are a small sized tax-exempt organization. With 5 employees, we face the same obstacles to
obtaining good, affordable health insurance coverage as those confronting small businesses in general.
Asa result, we are often captive to a small number of health insurance providers to access, and do not
have the economic clout of larger enterprises.

The ARC/STSA purchases heath insurance for our employees which is fully insured. We do not have the
resources or ability to self-insure as a means to control their health insurance costs and benefits. We will
greatly benefit from the expanded options for health insurance that will be available beginning in 2014
through the Exchange. The Exchange will allow our organization to benefit from the economics of
pooling that is not currently available.

However, because the benefits of the Exchange will not be realized until 2014, we will continue to
experience annual cost increases and lack of control over actual coverage until 2014. As such, the
grandfathering of our existing coverage is extremely important, especially prior to the establishment of a
working Exchange system.

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 we have the benefit of an Exchange, we are
concerned that we may be priced out of the market and may even have to drop coverage ~ something we
do not want to do and a bizarre result given the intent of health care reform.

Because we are small in terms of total numbers of employees, and because we cannot self-insure, we are
at the mercy of health insurance plans sold by private carriers. We do not have control over copays and
cost sharing. As such, simple changes to any plan are beyond our control and can cause our plan 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, we need to work with our 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.

We are concerned that Interim Final Rules as currently drafted may force us and organizations like us 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 smafi 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 us and similar 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 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.

Thank you for this opportunity to express our views on this important issue.