HealthReformGPS is made possible through generous financial support from the RCHN Community Health Foundation. Visit them at

Tag: Individual mandate

Report proposes theoretical ACA alternative

Posted by Sara Rothenberg on August 13, 2014

Manhattan Institute Senior Fellow Avik Roy proposed a health care plan that guarantees “near universal coverage and permanent fiscal solvency.” The Universal Exchange Plan would repeal the Affordable Care Act’s (ACA) individual and employer mandates and would transition Medicaid beneficiaries and future retirees into reformed health exchanges. The Manhattan Institute predicts the plan would expand coverage to 12.1 million more Americans than the ACA by 2025 and decrease individual market premiums 17 percentage points by 2020.

Continue Reading "Report proposes theoretical ACA alternative" »

CBO and JCT revise mandate penalty estimation

Posted by Nikki Hurt 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.

Continue Reading "CBO and JCT revise mandate penalty estimation" »

CBO estimate indicates impact of repealing the individual mandate

Posted by Nikki Hurt on March 13, 2014

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.

Continue Reading "CBO estimate indicates impact of repealing the individual mandate" »

EBSA and HHS rule expands excepted benefits

Posted by Nikki Hurt on December 30, 2013

A proposed rule released jointly by the Employee Benefits and Security Administration (EBSA) and the US Department of Health and Human Services (HHS) expanded the “excepted benefits” category under the 1996 Health Insurance Portability and Accountability Act (HIPAA) to include employee assistance programs. Excepted benefits include benefits related to health, but do not constitute comprehensive healthcare coverage, such as workers compensation, disability coverage, and auto insurance. Employee assistance programs, the newest excepted benefit, generally cover services such as substance abuse or mental health counseling, financial counseling, or legal services, and are usually provided to employees at no cost. Market reforms under the Affordable Care Act (ACA) do not apply to excepted benefits, and excepted benefits do not count as being covered under the individual mandate.

Continue Reading "EBSA and HHS rule expands excepted benefits" »

Editor’s Comment: What Policy Options Exist if the Website Remains Non-Functional?

Posted by Nikki Hurt on October 23, 2013

The federal website is limping along. The Administration has now taken a number of steps to begin to quickly and decisively address the problem, including adding a “surge” of technology experts to their contract teams and appointing a high-level overseer with extensive business management expertise. But fixing the website could take a long time…

Continue Reading "Editor’s Comment: What Policy Options Exist if the Website Remains Non-Functional?" »

CMS releases draft application for ACA exemptions

Posted by Nikki Hurt on October 16, 2013

The Centers for Medicare and Medicaid Services (CMS) issued a draft application and a corresponding data collection comment request concerning exemptions from the individual mandate. Under the Affordable Care Act (ACA), certain groups of individuals, such as those experiencing financial hardships or those that belong to a religious organization that opposes the use of insurance, are deemed exempt from the individual mandate and are therefore not required to pay the $95 penalty in 2014. This specific draft application, which is for individuals requesting a hardship exemption, is 6 pages in length and requires applicants to provide the type of hardship they are experiencing and their tax information. CMS anticipates that more than 12 million individuals will apply for the individual mandate exemption. The data collection comment request outlines options for states to rely on the Department of Health and Human Services (HHS) to determine eligibility exemptions, and asks the Office of Management and Budget (OMB) to approve the annual information collection requirements associated with the application.

Continue Reading "CMS releases draft application for ACA exemptions" »

Urban one-pager differentiates employer and individual mandates

Posted by Nikki Hurt on September 24, 2013

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.

Continue Reading "Urban one-pager differentiates employer and individual mandates" »

CBO scores House bill delaying individual and employer mandates

Posted by Nikki Hurt 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.

Continue Reading "CBO scores House bill delaying individual and employer mandates" »

CRS releases several ACA-related reports

Posted by Nikki Hurt 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.

Continue Reading "CRS releases several ACA-related reports" »

Urban Institute report compares impact of individual and employer mandates

Posted by Nikki Hurt on July 16, 2013

A new Urban Institute report explains how the employer shared responsibility payment, or employer mandate, has substantially less impact on the success of the Affordable Care Act (ACA) than the individual mandate. It’s No Contest: The ACA’s Employer Mandate Has Far Less Effect on Coverage and Costs Than the Individual Mandate, funded by the Robert Wood Johnson Foundation, details how Urban Institute utilized their Health Insurance Policy Simulation Model to compare coverage distribution with the full ACA, ACA without the employer mandate, and ACA without the individual mandate. The Urban Institute purports that although the delay of the employer mandate will have little appreciable impact on cost and coverage associated with the ACA, delaying the individual mandate would remove a pillar of the ACA, thereby inhibiting fulfillment of the law’s overarching intent.

Continue Reading "Urban Institute report compares impact of individual and employer mandates" »