Transparency, the Internet and the Affordable Care Act


Last year, I looked at the instances of the word “Internet” in the Senate version of the health care reform bill. Now that the Affordable Care Act is law it is worth reviewing this again. Nearly all instances of the word “Internet” in the law refer to online disclosure of information, data, reports and studies. The use of the word “Internet” increased from 66 in the Senate bill to 75 in the final law. For the most part the uses remain the same as those referenced in the post covering the Senate bill. Here’s what I wrote then:

The Department of Health and Human Services would be required to post nearly every report filed with the Department online. These reports range from information ensuring the quality of care provided by insurers to information meant to control premium increases. According to a source at a large cleveland hospice center, the various Internet disclosure provisions include new information on hospitals, hospice care and long term care facilities. New web sites would be created to provide information on affordable health care options and for the State administered health care exchanges.

Health and Human Services would be tasked with creating an Internet portal template for state administered health care exchanges. The web site template would provide information for individuals and employers to help them determine their eligibility for the exchange. The web site would also be required to present standardized information on the plans made available in the exchange including a rating to inform users to the basis of the relative quality and price of each plan offered.

Another of the bill’s Internet disclosure targets is affordable coverage. The bill tasks Health and Human Services with creating a web site to provide information on affordable coverage in each state. The provisions targets specific types of coverage for this disclosure including private coverage that is not limited to reimbursement for any one disease or condition or an “unreasonably limited” number of diseases and conditions. Other coverage options that must be disclosed and shown to be affordable on this web site include some Medicaid coverage and coverage under S-CHIP. The web site will also include standardized information on each plan including premium rates, cost sharing, premium revenue expended on non-clinical costs, eligibility and availability.

The bill also targets health insurers with a disclosure provision. The bill aims to control what it calls “unreasonable” premium increases by requiring insurers to provide a justification for such increases prior to the implementation of the increase. The justification must be made to the Department of Health and Human Services and simultaneously posted to the insurers web site in a prominent manner that the public can see.

Some online disclosure actions take effect soon. The Department of Health and Human Services must, by April 23rd, publish on their web site a list of all new authorities granted to the Department’s Secretary under the law. By July 1st of this year Health and Human Services must create, or facilitate in the state-creation of, an Internet web site to help people identify affordable health care options. In creating this site the Department must develop standardized formats for this information. These standardized formats must be completed by May 23rd of this year. Within one year of enactment the Department must create an Internet portal for the state level health care exchanges and create a template for state-level exchange web sites. These web sites will be required to disclose all costs of the exchanges as well as a wealth of information about the various health care plans available. The provision requiring health insurers to disclose and justify “unreasonable” premium increases prominently on their web sites begins with the Secretary creating a process, to begin this year, for the annual review and disclosure of such premium increases.