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

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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CMS documents describe presumptive eligibility

Posted on January 28, 2014 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) issued a bulletin and question-and-answer explaining hospital presumptive eligibility. The documents are intended to aid hospitals in determining individual eligibility for Medicaid, or presumptive eligibility, under the Affordable Care Act (ACA). The documents provide relevant information on eligible populations, entities that can make coverage determinations, qualification standards, and federal matching assistance that may be relevant for hospitals that may treat patients without insurance. All states are expected to include an amendment to their Medicaid State Plans implementing the new presumptive eligibility standards.

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HHS releases new FPL guidelines

Posted on January 27, 2014 | Comments Off

The US Department of Health and Human Services (HHS) updated the federal poverty level (FPL) guidelines for 2014. The guidelines, which are slightly higher than the 2013 levels, will not impact the eligibility thresholds used to determine subsidy eligibility for health insurance enrollment for 2014. For an individual, the the FPL is now set at $11,670, which represents a 1.6% increase from 2013.

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Supreme Court prevents enforcement of contraceptive mandate for religious organization

Posted on January 26, 2014 | Comments Off

A Supreme Court action issued Friday bars the federal government from enforcing the Affordable Care Act’s (ACA) contraceptive mandate on Little Sisters for the Poor, a non-profit organization of Catholic nuns that operates nursing homes. The organization claims that filing the requisite form to waive the contraceptive coverage mandate for organizations holding themselves out as religious entities would enable third party payers to cover contraceptives, which is against the organization’s beliefs. The Supreme Court’s ruling prevents any legal action against Little Sisters for the Poor until the appeal can be heard.

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Federal judge blocks prohibitive navigator laws in Missouri

Posted on January 24, 2014 | Comments Off

Yesterday, the US District Court for the Western District Court of Missouri released a decision blocking Missouri state laws that placed limitations and restrictions on state navigators and in-person assistors above and beyond those provided by the Affordable Care Act (ACA). Several states have placed additional requirements on navigators, or individuals intended to help consumers enroll in coverage under the ACA. This is the first lawsuit, however, challenging restrictive navigator laws in states operating a federally-facilitated marketplace.

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IRS documents address minimum essential coverage

Posted on January 24, 2014 | Comments Off

The Internal Revenue Service (IRS) released several documents concerning the maintenance of minimum essential coverage. The first document is a proposed rule issued concerning certain types of Medicaid coverage that do not satisfy the minimum essential coverage requirement under the Affordable Care Act (ACA). The proposed rule states that individuals with this coverage will not owe a shared responsibility payment. The proposed rule also outlines hardship exemptions and enrollment in employer-sponsored health insurance plans. In addition to the rule, the IRS released a notice stating that individuals with limited Medicaid coverage or limited coverage from military health benefits will not be subject to the individual shared responsibility payment.

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