California’s health exchange may require its health plans to pay sales commissions to insurance agents to keep insurers from shunning the sickest and costliest patients.

Covered California is working on a proposal that would force the plans to pay commissions effective next year, said Executive Director Peter Lee. The proposed rules could apply to regular and special enrollment periods, and would leave the specific commission amount or percentage up to insurers, he said.

Regulators in other states have warned insurers about altering commissions in a way that discriminates against higher-cost consumers, but Lee said Covered California may be the first exchange to adopt specific rules.

The state’s Kynect health insurance exchange is a financially unsustainable boondoggle that has cost $330 million, Gov. Matt Bevin’s top health officials told lawmakers at the Capitol Tuesday. Additionally, state spending on Medicaid will jump by 20 percent in the next two-year budget, to $3.7 billion, as federal support declines, they said.

“The day of reckoning has come, and we’re going to have to pay the bills,” Health and Family Services Secretary Vickie Yates Brown Glisson told the House budget subcommittee for human services.

The Department of Health and Human Services announced Friday night that it was in the process of shorting the U.S. Treasury $3.5 billion.

Well, they didn’t exactly announce it.  You had to read between the lines.

The theft of $3.5 billion will help prop up insurers that have agreed to sell ObamaCare policies in the individual market.  Behind all the happy talk from Administration officials about the program’s success lies an unpleasant truth: insurers that participate in ObamaCare exchanges are bleeding money.

Those losses are coming despite billions of dollars in handouts the government is providing the industry.  Some of those handouts are entirely lawful; others, not so much.

The so-called “reinsurance” program falls into the latter category.

The number of people who signed up for health insurance for 2016 on the state and federal exchanges was up to 40% lower than earlier government and private estimates, which some say is evidence that the plans are too expensive and that people would rather pay a penalty than buy them.

In 2010, the non-partisan Rand Corporation estimated 27 million people would have exchange policies this year and the Congressional Budget Office at that time was estimating 21 million for 2016. CBO even said last June that 20 million people would have plans purchased on the exchanges this year. Just 12.7 million signed up for plans, however, by the end of open enrollment Jan. 31 and about 1 million people are expected to drop their plans—or be dropped when they don’t pay their premiums.

Health insurers that sold plans on the exchanges in 2015 and enrolled droves of high-cost members, could haul away as much as $7.7 billion this year, as part of the healthcare law’s reinsurance program.

The CMS released a memo (PDF) late Friday that said the agency expects its jar of reinsurance money will total $7.7 billion. The payouts, to be issued this year, will reflect data from the 2015 benefit year.

The Obama administration is setting up a new ObamaCare sign-up period for people who failed to file 2014 tax returns.

Jan. 31 was the deadline for most people to sign up, but this new period will provide another chance until March 31, for certain people who might have missed out on coverage because of confusion about new ObamaCare requirements regarding taxes and health insurance.

New York regulators refuse to publicly release key documents that explain the failure of the nation’s largest ObamaCare health insurance co-op.

New York Department of Financial Services (DFS) reportedly launched an official investigation in September 2015 of Health Republic of New York for “substantial under-reporting” of its finances. Health Republic is one of 13 ObamaCare non-profit health insurance co-ops that have failed since the $2.5 billion program’s 2012 launch to compete with commercial for-profit insurance companies.

D. Monica Marsh, DFS’s principal attorney, told The Daily Caller News Foundation that Health Republic’s financial records aren’t being made public because doing so would have a “chilling effect” on the state’s official investigation.

 

The copay cap on drugs is one way Covered California chose to shape the health insurance marketplace this year. Experts say the California exchange uses more of its powers as an “active purchaser” than any other state. That means it can decide which insurers can join the exchange, what plans and benefits are available and at what price.

The federal government — in pending proposed rules for 2017 — has signaled it too wants to have more of a hand in crafting plans. Though there are no plans to go as far as a monthly drug copay cap, healthcare.gov would be forging ahead on a path California already paved, swapping variety for simplicity in plan design.

“Not letting [health] plans define what’s right for consumers, but defining it on behalf of consumers … is a better model for the market,” said Peter Lee, executive director of Covered California.

“We want to make sure every consumer has good choice but not infinite choice,” said Lee.

On February 5, 2016, the Centers for Medicare and Medicaid Services issued a guidance at its REGTAP.info recognizing a new special enrollment period (SEP), while the Departments of Labor, Treasury, and HHS issued a new guidance on student health plans.

Insurers have been sharply critical of SEPs in recent weeks, claiming that individuals who enroll through SEPS are unusually high cost and that SEP enrollees unbalance the risk pool. CMS has stated that it intends to tighten up on SEPs that might be subject to abuse. The agency retains statutory and regulatory authority, however, to recognize new SEPs where appropriate.

The new SEP recognized on February 5 is available for consumers who are without marketplace coverage because of their failure to file their taxes and reconcile advance premium tax credits (APTC) for 2014.

About 12.7 million people enrolled in ObamaCare plans this year, which is almost 9 million fewer than had once been expected and 1.4 million fewer than the upper boundary of its revised enrollment forecast.

Nevertheless, Health and Human Services secretary Sylvia Burwell declared the year “a success” and claimed that enrollment “exceeded our expectations.” In reality, ObamaCare enrollment has hit a wall.

At 12.7 million, total enrollment at the federal and state-run ObamaCare exchanges has ended up in the middle of range of the administration’s sharply lowered enrollment forecast, which they said could be anywhere from 11 million to 14.1 million for 2016. The Congressional Budget Office had previously expected enrollment to hit 21 million this year.