Posted on December 6, 2013
The Congressional Budget Office (CBO) recently released a report outlining 103 potential options to reduce federal spending or increase tax revenue. The report, Options for Reducing the Deficit: 2014 to 2023, contains 16 health-related provisions, several of which concern the Affordable Care Act (ACA), that may aid in reducing the deficit. These options include:
Posted on October 1, 2013
Several days ago, the Congressional Research Service (CRS) published a report describing how the appropriations impasse and government shutdown will impact the Affordable Care Act (ACA). The report provides background information on the ACA, particularly focusing upon how the law impacts federal spending. This information is followed by an explanation of the various legislative attempts to defund or amend the ACA, as well as legal and procedural considerations in using the appropriations process to attack the law. CRS concludes by examining how the government shutdown would impact ACA implementation. The report found that implementing the ACA would be largely unaffected by the government shutdown, because most of the federal agencies implementing the ACA will be able to rely upon funds outside of discretionary spending and several actions associated with implementing the ACA would be considered exceptions to the Antideficiency Act, the law that bars the federal government from performing certain tasks during a shutdown.
Posted on September 18, 2013
Today, the Republican Study Committee (RSC) released The American Health Care Reform Act, the RSC’s replacement version of the Affordable Care Act (ACA). Below are key components of this proposed legislative concept:
- Fully repeal the ACA
- Allow the purchasing of insurance across state borders
- Permit small businesses to pool together to increase their “buying power”
- Reform medical malpractice laws
- Increase access to health savings accounts (HSA)
- Strengthen state-based high risk pools to help protect individuals with pre-existing conditions from coverage discrimination
- Ensure that no federal funds are used for abortions
The RSC designed this proposal to reform the tax code without raising taxes, requiring an individual mandate, or including any subsidies. The proposal is an amalgamation of various Republican ideas on health care reform that have been touted over the years.
Posted on September 6, 2013
A cost estimate released today by the Congressional Budget Office (CBO) reported that delaying the individual and employer mandates within the Affordable Care Act (ACA) would reduce the federal deficit by $35 billion over 10 years. The CBO determined this value after scoring HR 2668, a bill delaying the mandate coverage provisions of the ACA, which passed the House in July. The Administration delayed the employer shared responsibility mandate for 2014 earlier this summer, but it is highly improbable that the Senate or Administration would consider delaying the individual mandate- regarded by most to be the crux of the ACA.
Posted on August 19, 2013
In a report, the Congressional Research Service (CRS) provides an explanation of the medical loss ratio (MLR). Under the Affordable Care Act (ACA), the MLR requires that insurers in the individual and small group market spend at least 80%, or 85% in the large group market, of premium dollars received on medical expenses for plan beneficiaries. If the insurer does not spend 80%, they must return the difference to beneficiaries in the form of a rebate. The MLR was instituted as a way to promote accountability and transparency for insurance company allocation of premium dollars. The CRS document clarifies that beneficiaries will only receive the rebate if the company as a whole does not meet the MLR threshold, not if the individual did not meet the threshold in his or her policy. Additionally, the MLR provisions only apply to fully-funded insurance plans. The CRS report also clarifies that some states do not have to adhere to MLR provisions if the US Department of Health and Human Services (HHS) determined that doing so would be detrimental to the state’s health insurance market.
Posted on July 30, 2013
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 24, 2013
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).
Posted on July 18, 2013
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 10, 2013
The Congressional Research Service (CRS) published a report exploring the key terms of the employer shared responsibility provision and methods to calculate full-time equivalent (FTE) employees. Pursuant to the Affordable Care Act (ACA), large employers will be penalized if they do not offer affordable health insurance to their full-time employees, and if one of their employees qualifies for a subsidy in the Exchange. Large employers are defined as entities with more than 50 FTE employees. The CRS memo addressed the confusion around calculating seasonal and part-time workers, which are assessed differently, in determining the number of FTE for the purposes of assigning penalties. Additionally, the CRS report outlines the methods for determining an employee’s full-time status at hire and safe harbor provisions associated with offering affordable coverage.
Posted on July 10, 2013
According to a new report released by the Congressional Research Service (CRS), small businesses would benefit from enrolling their employees in the Affordable Care Act’s (ACA) state and federal insurance Exchanges. The main attraction results from the ability for risk-sharing across a larger pool. Individuals with costlier health needs would be better able to afford premiums, as the costs would be spread amongst many more plan participants. Similarly, healthier individuals would be enticed to join the market, as their costs would decrease as a result of the broader insurance pool. In addition to the information on small businesses, the CRS document discussed the penalties associated with the employer shared responsibility payment, which has been delayed until 2015, and explores potential revisions that can mitigate the concerns associated with this penalty (i.e. exempting the first 49 employees for penalty assessment as opposed to the first 30).