Tag: 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.
Editor’s Comment: What Policy Options Exist if the Healthcare.gov Website Remains Non-Functional?
Posted by Nikki Hurt on October 23, 2013
The federal healthcare.gov 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…
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.
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.
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.
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.
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.
Federal judge dismisses challenge to individual mandate
Posted by Nikki Hurt on July 1, 2013
DC District Court Justice Beryl Howell dismissed a lawsuit against the Affordable Care Act’s (ACA) individual mandate. The lawsuit was brought forth under the Origination Clause, which states that all bills designed to raise revenue must originate in the House of Representatives. Justice Howell ruled that the ACA’s individual mandate was not created for the intent of raising revenue, and any shared responsibility penalty received by the government is a result of entities choosing not to obtain coverage, thereby “symbolizing the government’s failure to obtain its stated goal of universal coverage.”
HHS releases shorter Exchange enrollment application forms
Posted by Nikki Hurt on April 30, 2013
In response to the comments received on the length and complexity of the 21-page health insurance application draft, the US Department of Health and Human Services (HHS) has shaved down the application and released their second iteration this morning. Under the Affordable Care Act’s (ACA) individual mandate, most Americans are required to have insurance by January 1st, 2014. The new application released by HHS is designed to make the enrollment process more streamlined and simple. Individuals wishing to enroll into the Exchange will submit a 5-page document entitled “Application for Health Coverage and Help Paying Costs (Short Form).” The family application, “Application for Health Coverage and Help Paying Costs” comes in at 12-pages in length. HHS has also provided a 5-page application titled “Application for Health Coverage” for anyone wishing to enter the Exchange, but is unsure of their eligibility.
Health Affairs study indicates financial burden of ACA
Posted by Nikki Hurt on April 18, 2013
A recent study released by Health Affairs found some families, particularly those that do not receive employer-sponsored health insurance or do not qualify for Medicaid, may experience financial hardship as a result of purchasing health insurance through the Affordable Care Act (ACA). The study focused on 393 families that purchased unsubsidized health insurance through the Massachusetts Commonwealth Health Insurance Connector Authority, and found that families with smaller incomes, multiple children, and poor health conditions had to pay more of their health care costs out-of-pocket. Authors of the study postulate that these findings can be generalized to families in similar situations across the country, indicating a potential financial risk associated with the health insurance individual mandate in the ACA.