Posted on July 30, 2013 | Comments Off
In a letter addressed to Rep. Paul Ryan, the Congressional Budget Office (CBO) stated that the administration’s decision to delay the employer shared responsibility (employer mandate) provisions of the Affordable Care Act (ACA) would cost the government $12 billion over 10 years. CBO estimated that around $10 billion would be lost from the one-year delay in collecting penalties from employers that did not offer comprehensive, affordable coverage. An additional $3 billion is projected to be lost from the government over-allocating subsidies to individuals qualifying for premium assistance. CBO did, however, project the delay to generate around $1 billion in savings as a result of taxable compensation from people enrolling in Exchanges that would have otherwise received employer-sponsored coverage.
Posted on July 26, 2013 | Comments Off
Maryland joined the ranks of several other states by releasing their final premium rates to be offered on their state health benefits Exchange, Maryland Health Connection. Maryland’s rate review process consisted of four steps: statisticians and actuaries performed analyses to verify the methods by which insurers determined their rate offerings; forms reviewers confirmed the insurers complied with state and federal regulations; public comments were requested and reviewed; and finally, the Insurance Commissioner approved, modified, or denied the request presented by the insurers. These steps resulted in the final values just released, which have been touted for being lower than anticipated.
Posted on July 25, 2013 | Comments Off
A new report released by the US Department of Health and Human Services Office of Inspector General (OIG) purports that Consumer Operated and Oriented Plan (CO-OP) issuers have achieved 90% of their implementation goals. Under the Affordable Care Act (ACA), CO-OP loans were provided to create non-profit health plans that were effectively consumer initiated and executed in 24 states. Although these CO-OPs have been successful in development, much uncertainty and concern still remains around the ultimate success of these programs. The report, Early Implementation of the Consumer Operated and Oriented Plan Loan Program, found that many factors, such as competition in state insurance Exchanges and the health status of enrollees, will determine whether or not CO-OPs will be beneficial for plan participants.
Posted on July 24, 2013 | Comments Off
A new report released by the Government Accountability Office (GAO) aggregates the baseline premium prices available through each state’s individual market. The values presented were self-reported by insurance companies and were retrieved from the HealthCare.gov Plan Finder during January 2013. The report, requested by Senator Orrin Hatch (R-UT), will likely be used to see exactly how much premiums will change for individuals across the country as a result of the various provisions of the Affordable Care Act (ACA).
Implementation Brief Update: Reporting Information about Employer Coverage for Purposes of Shared Responsibility and Premium Assistance: Transitional Relief for 2014
Posted on July 23, 2013 | Public Comment (1)
On July 2, 2013, the Obama Administration posted a blog announcing a one-year delay (from 2014 to 2015) in implementing the shared responsibility provisions of the Affordable Care Act (ACA) applicable to large employers. The blog was followed by brief IRS policy guidance, as well as by a final HHS rule implementing the process by which Exchanges will ascertain the eligibility of individuals who apply for premium tax credits because they lack access to “affordable” employer-sponsored coverage that provides “minimum value.”
Posted on July 19, 2013 | Comments Off
The US Department of Health and Human Services (HHS) announced today the awarding of $12 million in Affordable Care Act (ACA) funding to train more than 300 new primary care residents during the 2013-2014 academic year. The funds, administered by the Health Resources and Services Administration (HRSA), will be provided to 32 Teaching Health Centers in a total of 21 states throughout the country. Due to Medicaid expansion and the growing insured population resulting from the ACA, this allocation of funding is pivotal to meet the anticipated demand of primary care physicians.
Posted on July 18, 2013 | Comments Off
A new report from the Congressional Research Service (CRS) describes the application of premium credits to help individuals subsidize their health insurance purchased through the Affordable Care Act’s (ACA) Exchanges. The report, Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (ACA), provides examples as to how premium tax credits would be allocated based upon age and income level, assuming the credits were operational and applicable to 2012. The memo states that premium tax credits are advanceable, refundable, and reconcilable. Additionally, cost-sharing subsidies, such as reduced co-payments, may be available for some individuals with lower incomes.
Another CRS memo provides a basic overview of the individual mandate, the requirement of all Americans, with the exception of individuals qualifying for exemptions, to obtain minimum essential coverage. Those that are not exempt and remain non-compliant with the mandate will be assessed a penalty beginning in 2014. In addition to penalty assessment, the memo explains the reporting requirements associated with the ACA. Individual Mandate and Related Information Requirements under ACA was commissioned in response to HR 2668, the Fairness for American Families Act, which delays the implementation of the individual mandate to 2015.
In response to the delay of the employer shared responsibility payment, or the employer mandate, CRS also released a report detailing impact the decision may have on health insurance coverage and eligibility. Some of the potential issues addressed in the CRS memo include: fewer than anticipated “large” employers offering insurance coverage, more than anticipated employees qualifying for premium tax credits, and concerns with verification of tax credit eligibility to prevent fraud and abuse. This report was released in regards to HR 2667, Delay in Implementation of Potential Employer Penalties Under ACA, the legislative delay of the ACA employer penalties.
Posted on July 16, 2013 | Comments Off
A new Urban Institute report explains how the employer shared responsibility payment, or employer mandate, has substantially less impact on the success of the Affordable Care Act (ACA) than the individual mandate. It’s No Contest: The ACA’s Employer Mandate Has Far Less Effect on Coverage and Costs Than the Individual Mandate, funded by the Robert Wood Johnson Foundation, details how Urban Institute utilized their Health Insurance Policy Simulation Model to compare coverage distribution with the full ACA, ACA without the employer mandate, and ACA without the individual mandate. The Urban Institute purports that although the delay of the employer mandate will have little appreciable impact on cost and coverage associated with the ACA, delaying the individual mandate would remove a pillar of the ACA, thereby inhibiting fulfillment of the law’s overarching intent.
Implementation Brief Update: Final Rule on Medicaid and CHIP, Including Essential Health Benefits in Alternative Benefit Plans; Eligibility Notices, Fair Hearings and Appeals Processes; Premiums and Cost Sharing; and Exchange Eligibility and Enrollment
Posted on July 16, 2013 | Comments Off
On July 5, 2013, the Obama Administration published final rules implementing various provisions of the Affordable Care Act related to Medicaid and CHIP, premiums and cost-sharing, and Exchange eligibility and enrollment. This Update discusses the highlights of this very long rule, which modifies final regulations published in March 2012 as well as previous proposed regulations. The final rule contains four major parts:
A. Medicaid Eligibility Part II Final Rule
B. Essential Health Benefits in Alternative Benefit Plans
C. Exchanges: Eligibility and Enrollment
D. Medicaid Premiums and Cost-sharing
In general, the final rule was adopted with very few changes. At the same time, CMS noted that certain aspects of the proposed rules remain un-finalized, pending additional implementation activities, including further changes necessitated by the Administration’s decision to delay employer compliance-related reporting requirements in connection with the Act’s employer responsibility provisions.
Posted on July 12, 2013 | Public Comments (3)
Today, the US Department of Health and Human Services (HHS) issued their final rule concerning Navigators and other forms of in-person assisters. These rules apply to navigation personnel in federally-facilitated and partnership Exchanges, as well as non-Navigator assisters in state-based Exchanges funded through federal grants. Below are the key provisions addressed in the final rule:
- Exchanges must designate certain organizations to train and certify staff and volunteers as application counselors. Application counselors are individuals that assist consumers in completing their Exchange enrollment applications for either public or private insurance.
- An individual or group with ties to stop loss insurance issuers may not become a Navigator. The rule further states that some of the eligibility criteria utilized to determine whether or not one can be a Navigator may also be applied to individuals aspiring to become other forms of non-Navigator assisters.
- The rule solidifies Navigator training standards on the following issues: conflicts-of-interest, training and certification, and meaningful access.
- Any licensing or certification requirements issued by states may not conflict with the provisions laid forth in title I of the Affordable Care Act (ACA).
The Center for Consumer Information and Information Oversight (CCIIO) simultaneously released guidance concerning the Certified Application Counselor Program for federally-facilitated and state-partnership Exchanges. The guidance includes which organizations may be designated Certified Application Counselors, how to go about the designation, and how to remove the designation.