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Congressional Documents

GAO releases report on CHIP

Posted on March 28, 2015

The Government Accountability Office (GAO) issued a report finding that coverage of services in the selected State Children’s Health Insurance Program (CHIP) plans was generally comparable to that of the selected private qualified health plans (QHP) under the Affordable Care Act (ACA). However, GAO found notable exceptions with pediatric dental and certain enabling services, such as translation and transportation services, which were covered more frequently by CHIP plans. Selected CHIP plans and QHPs were also similar in terms of the services on which they imposed day, visit, or dollar limits, although the five selected CHIP plans generally imposed fewer limits than the selected QHPs. Additionally, GAO found that consumers’ costs for services (deductibles, copayments, coinsurance, and premiums) were almost always less in the selected CHIP plans when compared to their respective QHPs, despite the application of subsidies authorized under the ACA that reduce these costs.

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GAO issues new report on premium tax credits and ACA coverage

Posted on March 26, 2015

The Government Accountability Office (GAO) released a new report finding that premium tax credits have likely contributed to an expansion of health insurance coverage in 2014 by significantly reducing the cost of exchange plans’ premiums for those eligible.  The GAO report cited surveys finding that the uninsured rate declined significantly among households with incomes eligible for the premium subsidies. One survey found that the rate of uninsured individuals with household incomes eligible for premium tax credits fell 5.2 percentage points between September 2013 and September 2014. However, many still face challenges maintaining coverage. GAO found most nonelderly adults had access to affordable plans through their employer, Medicaid, the exchanges, or other sources as of March 2014, although about 16 percent of nonelderly adults remained uninsured.

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GAO issues Medicaid report

Posted on February 17, 2015

The Government Accountability Office (GAO) issued a report examining (1) the extent to which Medicaid enrollees have private insurance, and (2) state and CMS initiatives to improve third-party liability (TPL) efforts. GAO found that 7.6 million Medicaid enrollees (13.4 percent) had private health insurance in 2012. Additionally, the number of Medicaid enrollees with private health insurance is expected to increase with the expansion of Medicaid. To combat this issue, GAO recommends that the Centers for Medicare and Medicaid Services (CMS) routinely monitor and share across all states information regarding key TPL efforts and challenges, as well as provide guidance on state oversight of TPL efforts conducted by Medicaid managed care plans.

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New CBO report estimates ACA costs

Posted on January 26, 2015

A new report released by the Congressional Budget Office (CBO) estimates that the coverage provisions of the Affordable Care Act (ACA) will result in $76 billion in net costs to the federal government in 2015 and $1,350 billion between 2016 and 2025. These costs come almost entirely from tax subsidies, accounting for $32 billion in 2015, and from the increase in spending from Medicaid expansions, $47 billion in 2015. CBO predicts that these costs will be offset slightly by an estimated $2 billion in penalties paid by the uninsured in 2015. This new CBO estimate of the ACA’s coverage provisions represents a 7 percent decline since their last estimate.

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GAO issues report on SHOP exchanges

Posted on November 14, 2014

A new Government Accountability Office (GAO) report reveals that only only 76,000 people enrolled in the 18 states running their own Small Business Health Options Program (SHOP) exchanges as of June 1. While GAO did not have data for the federal-run SHOP exchanges, CMS told the office that it expected similar enrollment trends for the small business marketplaces it is operating. A number of factors may be contributing to the low enrollment numbers such as a lack of interest in the Affordable Care Act’s (ACA) small business health tax credits, misconceptions about SHOP availability by employers, and the ability of employers to renew pre-ACA plans. GAO noted that these factors may also affect future growth.

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CRS publishes report on ACA repeal legislation

Posted on November 3, 2014

The Congressional Research Service issued a report summarizing legislative actions to repeal, defund, delay, or amend the Affordable Care Act (ACA). The report compiles legislation that has been approved by both chambers and enacted into law, legislation passed in the House not considered by the Senate, and ACA-related provisions in enacted annual appropriations acts for each of FY2011 through FY2014. Also included is a brief overview of all the ACA-related provisions added to appropriations bills considered, and in most cases reported, by the House and Senate Appropriations Committees since FY2011.

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GAO report finds insurers aren’t separating abortion funds

Posted on September 17, 2014

A new Government Accountability Office (GAO) report found that 15 insurers in a sample of 18 are selling Affordable Care Act (ACA) plans that do not segregate funds to cover abortion from their ACA subsidies, despite the ACA requirement  that insurers collect separate payments from customers for abortion coverage. The report was commissioned by House Republican leadership amid concerns that  customers were able to use federal health care subsidies on insurance policies that cover abortion procedures. However, about half of the states have passed laws forbidding exchange plans from covering abortion at all, so this issue may not be nationally pervasive.

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Report finds weaknesses in ACA enrollment controls

Posted on July 22, 2014

The Government Accountability Office (GAO) issued a preliminary report finding that fraud controls for enrollment in health care coverage and consumer subsidies under the Affordable Care Act (ACA) may be lacking. Congressional investigators using fake identities were able to obtain taxpayer-subsidized health insurance on Affordable Insurance Exchanges. The report’s findings were contained in testimony delivered at a House Ways and Means Committee hearing on July 23.

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Study assesses states’ Medicaid spending per enrollee

Posted on July 17, 2014

A new Government Accountability Office (GAO) report finds that eight states spent at least $10,500 per Medicaid recipient in 2008, while the majority of states were clustered in the $6,000-$8,000 range, per enrollee. For Fiscal Year (FY) 2013 Medicaid spending is estimated at $267 billion, a figure that is expected to nearly double by FY 2024. The GAO’s report assessed why there is so much variation in per-enrollee spending across states and how states account for those differences when setting Medicaid managed care rates.

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CBO and JCT revise mandate penalty estimation

Posted on June 5, 2014

An updated analysis released by the Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) estimates that 2 million fewer individuals are anticipated to pay the shared responsibility payment in 2016. Under the Affordable Care Act (ACA), most individuals not receiving minimum essential coverage through their insurance plans are expected to pay a fine for not complying with the individual mandate. The last estimate released by the analysts in 2012 postulated that 6 million individuals way pay the fine in 2016. CBO and JCT cite the expected increase in the number of individuals receiving exemptions from the individual mandate as the main reason for the estimated drop.

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