The Obama administration wasn’t able to ensure that all tax-credit payments made to insurers under the health law in 2014 were on behalf of consumers who had paid their premiums, according to a federal oversight agency. The Health and Human Services’ Office of Inspector General released the report Wednesday. The findings raise questions about the oversight of tax-credit payments that went to insurers on behalf of consumers who qualified for financial assistance.
UnitedHealth Group Inc., the largest U.S. health insurer, said its rates for ObamaCare plans in New York may be too low because the failure of a competing insurer last year might lead to shortfalls in payments designed to stabilize Obamacare markets.
In states like New York, health insurers participating in ObamaCare negotiate annually with regulators to set prices for coverage. UnitedHealth’s rates were set anticipating risk-sharing payments designed to stabilize the new insurance markets, William Golden, the company’s northeast region chief executive officer, said Wednesday. If the loss of a participant reduces the funds available to UnitedHealth, the company’s rates in New York’s ObamaCare market may be insufficient, he said.
Going into President Barack Obama’s last year in office, progress has stalled on reducing the number of uninsured Americans under his signature health care law, according to a major survey out Thursday.
The share of U.S. adults without health insurance was 11.9% in the last three months of 2015, essentially unchanged from the start of the year, according to the Gallup-Healthways Well-Being Index. The ongoing survey, based on daily interviews with 500 people, has been used by media, social scientists, and administration officials to track the law’s impact.
Are New Yorkers looking at a health insurance tax to pay for the more than $200 million in unpaid doctor and hospital bills remaining after the collapse of the state’s consumer-run nonprofit insurance co-op? Or could that money come from the billions in bank settlements that have flowed to state coffers in recent years?
Those are among the questions that lawmakers and Gov. Andrew Cuomo will likely be debating in the upcoming legislative session. Also unclear is the future status of the approximately 215,000 New Yorkers who had low-cost health insurance policies through the short-lived Health Republic co-op.
The Department of Health & Human Services’ Office of the Inspector General found that the Centers for Medicare & Medicaid Services (CMS):
• Did not have an effective process in place to ensure that advance premium tax credit (APTC) payments were made only for enrollees who had paid their monthly premiums; instead, CMS relied on each qualified health plan (QHP) issuer to verify that enrollees paid their monthly premiums and to attest that APTC payment information that the issuer reported on its template was accurate; and
• Had sole responsibility for ensuring that APTC payments were made only for confirmed enrollees and did not share these data for enrollees with the IRS when making payments.
The OIG determined that CMS’s processes limited its ability to ensure that APTC payments made to QHP issuers were only for enrollees who had made their premium payments.
Most discussions about insurance costs center around premium increases, or (less often) deductibles. Less often do we here them discussed together. Yet, the combination is a critical factor in determining how illnesses affect the financial well-being of families.
An insured family has to pay its premium regardless of whether or not any claims are made. In addition, a family has to meet its annual deductible before receiving any benefits for treatment of illnesses or injuries. That means a family has to pay the total of the premium plus the deductible before any benefits are payable.
The health insurance industry will be watching and waiting to see if antitrust regulators approve several big insurance mergers, whether the Affordable Care Act’s exchange market grows more sustainable, and whether states adopt new regulations governing provider network adequacy.
Looming above all those issues is the possibility of the election of a Republican president who would seek to jettison the ACA framework and replace it with an entirely different healthcare financing framework.
Poor planning and a “lack of effective leadership” within the state Department of Human Services prevented the department’s $155 million computer system from meeting the goals of the federal Affordable Care Act, according to a report released today by the Hawaii State Auditor.
The system has not been able to meet federal goals of creating a simple, real-time process for enrolling and determining eligibility for coverage, according to the auditor.
Obama administration officials said last month that about 2.5 million new customers had bought insurance through HealthCare.gov since open enrollment began on Nov. 1. The number of new enrollees is 29% higher than last year at this time, suggesting that the threat of a larger penalty may be motivating more people to get covered.
But plenty of healthy holdouts remain, and their resistance helps explain why insurers are worried about the financial viability of the exchanges over time. People who earn too much to qualify for federal subsidies that defray the cost of coverage may be most likely to opt out.
Many insurance companies are losing money selling ObamaCare policies. Unfortunately, the White House wants to make their losses your problem. In December, Congress refused an administration request to provide insurers with $2.5 billion in bailout money to help cover their 2014 losses.
The Obama administration hasn’t given up. It has declared that this $2.5 billion in corporate welfare and potentially billions more for losses insurers have incurred in 2015 is “an obligation of the U.S. government for which full payment is required.”