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CBO report finds more consumers will face ACA individual mandate penalty

Posted on September 19, 2012 | No Comments

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According to a new Congressional Budget Office (CBO) report, about six million people will face tax penalties in 2016. This mean that two million more Americans than initially projected will face penalties from 2017 to 2022. These penalties translate into $7 billion. The CBO reported that 85 percent of the increase can is attributable to higher unemployment rates, lower wages, and “technical updates.” CBO attributed little to the Supreme Court decision to make optional Medicaid expansion.

This number makes up just a fraction of those who will remain uninsured after full Affordable Care Act (ACA) implementation – 30 million in total, according to CBO. Those exempt from the ACA’s minimum coverage provision include illegal immigrants, low-income individuals, those without affordable insurance options, American Indian tribe members, and individuals whose religious beliefs precludes them from entering the market.

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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.
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.
The Congressional Budget Office (CBO) score of HR 4015 found that repealing the Affordable Care Act's (ACA) individual mandate would save the government $169.5 billion over the next 10 years. Doing so would also result in 13 million fewer individuals having insurance by 2018, and those with insurance would pay more for their coverage. Lifting the individual mandate is the current pay-for for the House bill to reform the Sustainable Growth Rate (SGR). The savings from removing the mandate would arise from the decreased issuance of health insurance subsidies, or premium tax credits.
A table compiled by the Urban Institute succinctly summarizes the drastically different impacts of delaying the employer and individual mandates. Ultimately, delaying the employer mandate until 2015 will have little impact on uninsured numbers, premium rates, and the financial stability of hospitals that offer a disproportionately high quantity of uncompensated care. Delaying the individual mandate, however, would negatively impact the insurance market by substantially raising premium prices and harming disproportionate share hospitals.
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.
The Center for Consumer Information and Insurance Oversight (CCIIO), within the Centers for Medicare and Medicaid Services (CMS), published an FAQ concerning the open enrollment period for individuals purchasing qualified health plans (QHPs) under the Affordable Care Act (ACA). The guidance states that individuals will be able to enroll in QHPs throughout the entire enrollment period, which lasts through March 31st, and not be subject to the individual shared responsibility payment. According to the ACA, individuals would have to enroll in a plan by the 15th of each month in order for their QHP coverage to be effective at the start of the following month. Individuals that enrolled in plans after the 15th would not be covered for another two months. The issue pertains to individuals that would enroll in QHPs between February 16th and February 28th of 2014. These individuals would not be covered until April 1st, and would therefore be subject to the minimum essential coverage penalty under the ACA (the minimum essential coverage provision states that an individual must pay a penalty if he or she does not have coverage for more than three consecutive months in a year). This guidance removes that snafu in the law and states that CCIIO will provide additional guidance on the issue in 2014.
A final rule released by the Internal Revenue Service (IRS) explains the individual shared responsibility payment for not obtaining basic insurance coverage, or minimum essential coverage, under the Affordable Care Act (ACA). By 2014, most Americans are expected to possess minimum essential coverage or face a tax penalty under Section 5000A of the Internal Revenue Code. Individuals without minimum essential coverage will pay an annual fine of $95 in 2014, $325 or 2% of their income in 2015, and $695 or 2.5% of their income in 2016 and beyond. Since many Americans will be exempt from this provision for a multitude of reasons (hardship, unaffordability, religious beliefs, etc.), the Congressional Budget Office (CBO) estimates that only 2% of Americans will face the penalty. In addition to the final rule, the IRS released a fact sheet that highlights several of the key points addressed in the rule. The fact sheet discusses how the rule clarifies hardship exemptions and partial month coverage (i.e. an individual has maintained minimum essential coverage as long as he or she has coverage for at least one day of the month). Specific coverage categories to which minimum essential coverage provisions apply are enumerated, and the processes for obtaining an exemption are also described.
On August 30, 2013, the IRS published final regulations implementing the shared responsibility provisions of the Affordable Care Act (78 Fed. Reg. 53646-53664). The regulations address, among other matters, the complex question of when Medicaid eligibility amounts to minimum essential coverage (MEC) for purposes of the Act’s tax penalties. Because people with MEC are barred from receiving premium and cost sharing assistance for Marketplace plans, the final rules also have important implications in the area of health policy for children and adults with disabilities, who may need both basic insurance and supplemental Medicaid coverage for their more extensive health care needs. Many of Medicaid’s most important disability-related eligibility categories are optional with states and, therefore, monitoring whether and how agency policy on when Medicaid counts as MEC will be an important issue to watch over time.
The Supreme Court handed down its long-awaited ruling in the case of National Federation of Independent Businesses et al. v. Sebelius, Secretary of Health and Human Services, et al., upholding the individual requirement to maintain insurance coverage as a reasonable exercise of Congress’s taxing and spending authority and also upholding the constitutionality of the Medicaid coverage expansion. In a surprise coalition, Chief Justice Roberts was joined in his majority opinion by Justices Stephen Breyer, Ruth Bader Ginsburg, Sonia Sotomayor and Elena Kagan. The summary below describes the majority opinion, the concurring opinion (authored by Justice Ginsburg), and the dissenting opinion (written by Justice Scalia). Because the Court upheld the individual mandate, it never reached...