A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

CMS bulletin allows individuals to change insurance plans

Posted on February 11, 2014 | Public Comment (1)

Guidance recently released by the Centers for Medicare and Medicaid Services (CMS) states that individuals who have paid their first month’s premium and have already received coverage may change their insurance plan in order to obtain a more robust provider network. The guidance, which consists of five bulletins, provides information for both issuers and consumers in federally-facilitated and state-partnership marketplaces regarding the ability to alter application information or plan selections based upon certain life events or changes in enrollment periods.

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IRS rule addresses employer mandate, calculating teacher hours

Posted on February 11, 2014 | Comments Off

A new rule issued by the Internal Revenue Service (IRS) addresses several components of the employer shared responsibility provisions within the Affordable Care Act (ACA). The rule further delays the employer shared responsibility payment for medium-sized businesses (50-100 employees) until 2016. Large employers will be able to phase in the percentage of full-time employees to whom they must provide health insurance, starting with 70% in 2015 and moving to 95% by 2016. IRS also released a fact sheet to accompany this rule. Additionally, this rule stated that teachers cannot be considered part-time employees because many do not work a full summer schedule.

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Implementation Brief When Does Medicaid Coverage Amount to Minimum Essential Coverage Under the Affordable Care Act? An Update on the Treasury/IRS Rules Defining Minimum Essential Coverage

Posted on February 11, 2014 | Comments Off

A January 27, 2014 proposed rule in the Federal Register (79 Fed. Reg. 4302-4308) published by Treasury/IRS would add further clarification to the question of under what circumstances the agencies will classify Medicaid as minimum essential coverage (MEC) for purposes of satisfying the Affordable Care Act’s requirement to maintain MEC or pay a shared responsibility tax. Comments are due by April 28, 2014; the agencies also intend to hold a public hearing on the NPRM which covers Medicaid as well as other types of coverage.

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CBO FAQ clarifies recent report

Posted on February 10, 2014 | Comments Off

A new set of frequently asked questions (FAQ) was published today by Douglas Elmendorf, the Director of the Congressional Budget Office (CBO), in an effort to clarify some of the misconceptions concerning CBO’s report released last week. The FAQ clarifies that 2.5 million Americans will not lose their jobs as a result of the Affordable Care Act (ACA), but will instead no longer feel forced to remain employed just to receive healthcare. The FAQ also addresses why CBO chose to revisit the labor market in their study.

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OPM wants to expand MSP for 2015

Posted on February 6, 2014 | Comments Off

The Office of Personnel Management (OPM) intends to expand Multi-State Plans (MSP) in 2015. The MSP program, designed to be an alternative to the public option, currently consists of 150 plans across 30 states and DC. OPM intends to include one more issuer and five more states in the MSP program in 2015.

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CMS releases 2015 Letter to Issuers draft

Posted on February 4, 2014 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) released the draft version of the 2015 Letter to Issuers. This letter outlines key dates and guidance for health plan issuers interested in selling qualified health plans (QHP) on the federally-facilitated marketplace in 2015. The letter, which applies to issuers for both the individual and Small Business Health Options Program (SHOP) marketplaces, particularly focuses upon enhanced plan standards for network adequacy, essential community providers, and patient safety metrics.

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Federal government releases several ACA related documents

Posted on February 4, 2014 | Comments Off

Several documents concerning the Affordable Care Act (ACA) have been recently released by different entities within the federal government. A letter from the Congressional Research Service (CRS) to the US House of Representatives Energy and Commerce Committee concerning the risk corridor provisions within the ACA surfaced today. The risk corridor was designed to aid insurance companies who may enroll a disproportionate number of less-healthy, or riskier, individuals. A new report from the Government Accountability Office (GAO) provides information on baseline premiums for individuals aged 19 to 64 across all 50 states. GAO used information available on healthcare.gov to assess the lowest premium amounts available to consumers in January 2014. The Congressional Budget Office (CBO) released their report, The Budget and Economic Outlook: 2014-2024, which stated that 6 million Americans will receive health insurance from ACA marketplaces, 1 million less than previously anticipated. The report also claimed that full-time employment by 2016 will be reduced by nearly 2 million individuals, which the CBO is attributing to a reduction in the number of hours worked as a result of employers being required to offer health care benefits for full-time employees.

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CRS report provides FAQs on contractors and healthcare.gov

Posted on January 31, 2014 | Comments Off

The Congressional Research Service (CRS) issued a new report containing frequently asked questions (FAQs) concerning healthcare.gov contractors. Given the rocky roll out of healthcare.gov, CRS intended to answer common questions about the role of contractor procurement and performance. The CRS report explicitly highlights that questions are answered in general terms in an effort to protect the rights of the contracted parties and avoid the specifics of each document.

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PwC report finds Marketplace premiums comparable to employer-sponsored coverage

Posted on January 31, 2014 | Comments Off

A new report released by PricewaterhouseCoopers (PwC) Health Research Institute found that premiums for plans offered through the Affordable Care Act’s (ACA) health insurance marketplace were comparable, if not cheaper, than premiums of plans offered by employers. The report, Health insurance premiums:comparing ACA exchange rates to the employer-based market, noted several causes for this difference. First, many plans offered through the ACA marketplace have thinner networks, which will drive down costs. Second, premium rates between the public and private sectors may equilibrate after the ACA marketplace has been established for several years.

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Brookings report finds ACA will shift incomes

Posted on January 28, 2014 | Comments Off

A report recently released by The Brookings Institution stated that the Affordable Care Act (ACA) will lead to a redistribution of incomes. Specifically, the report cited that individuals with incomes in the bottom 20% of the population will see a 6% increase due to the availability of subsidies and Medicaid expansion, while individuals in higher income brackets may see a slight reduction in their incomes based upon higher taxes and shifts in the insurance market. Of note, the authors of the report include “government and employer contributions to health insurance” in their determinations for income.

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