“New language in contracts between the CMS and insurers operating on HealthCare.gov is grabbing attention, with some calling it an admission by the government that it might lose upcoming court battles dealing with insurance subsidies on the health portal and others saying the new wording is just a practical precaution.
The new language appears to allow insurers to stop offering their plans should federal premium subsidies disappear. A number of cases regarding the legality of the subsidies in states without their own exchanges are now working their way through the courts.
The language says, “CMS acknowledges that (the insurer) has developed its products for the (federal exchange) based on the assumption that (advance payments of the premium tax credit) and (cost-sharing reductions) will be available to qualifying enrollees. In the event that this assumption ceases to be valid during the term of this agreement, CMS acknowledges that issuer could have cause to terminate this agreement subject to applicable state and federal law.””
“WASHINGTON — With health insurance marketplaces about to open for 2015 enrollment, the Obama administration has told insurance companies that it will delay requirements for them to disclose data on the number of people enrolled, the number of claims denied and the costs to consumers for specific services.
For months, insurers have been asking the administration if they had to comply with two sections of the Affordable Care Act that require “transparency in coverage.””
“If you bought health insurance on HealthCare.gov for this year, you could be in for a few surprises when open enrollment begins next month.
It’s possible, for example, that you could end up being billed for two different plans. The reason, insurers say, is because the federal government hasn’t addressed a key communications issue with the website.
And if you haven’t updated your financial information on the online insurance marketplace, you could face higher premiums and get less of a subsidy than you deserve.”
“Hanging around actuaries as long as I have one of the old sayings I picked up was, “Figures don’t lie, but liars figure.”
I have read one story after another this summer and fall about the modest Obamacare rates increases––or decreases––for 2015.
On this blog you have also seen me write about the complex way the 2015 Obamacare rates will hit people particularly because of the impact the changes in the so called second lowest cost Silver plan will have on so many people’s final subsidy. You have also seen me write about the fact that we really won’t know what Obamacare costs people until the now unlimited Obamacare reinsurance program stops subsidizing insurance rates in 2017.”
“After the worst transition to Obamacare in the country, Massachusetts is still without a functional exchange website and just 769 people have enrolled in Obamacare-subsidized plans.
To avoid accountability and political repercussions, Massachusetts Gov. Deval Patrick is about to cut two special deals with the federal government: the “Commonwealth Kickback” which grants Massachusetts the most generous taxpayer-funded premium subsidies in the entire country, while the “Bay State Bailout” gives 300,000+ MA residents “temporary” Medicaid coverage in 2014, without any verification of their eligibility.
These deals are reminiscent of the controversial ACA-related “Cornhusker Kickback” and “Louisiana Purchase,” but they also can be added to the growing list of special deals cut for Massachusetts as the state struggles to transition to the ACA.”
“As President Barack Obama’s administration gears up for its second open enrollment period next month, the president’s health care overhaul is now facing two new threats. Either piece of news, on its own, should warrant concern from the law’s most ardent supporters for the program’s long-term prospects.
The first threat is a group of legal challenges to the law that are making their way through the courts. At issue is what the plain text of Section 1401 of the Affordable Care Act means. Even though the text of the law states that the subsidies are available “through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act,” the Internal Revenue Service (IRS), without congressional authorization, allowed federal subsidies to flow into states participating in the federal exchange when it implemented the law.”
“Americans are angry about the manifest failure of Obamacare. Many have felt the impact directly, from the millions who lost their health plans after being promised they could keep them, to those facing sky-high deductibles and premiums, to those — including some in the midst of cancer treatments — who are losing access to their family doctors.
But at the same time, Americans want insurance that is secure and covers treatments they need. They want the uninsured and those with preexisting conditions to have access to coverage, and they know costs are rising dramatically. They know a safety net is needed for those who lose coverage, particularly those undergoing treatments for serious diseases.”
“ObamaCare rate increases are coming to some key battleground states, fueling Republican attacks ahead of next month’s midterm elections.
“It looks like we’re going to have double-digit premium increases in places like Alaska, and Iowa and Louisiana,” said health economist John Goodman. “Where we’ve got very close races for Senate, and Republican candidates are making a big deal over this.””
“Almost immediately after the state’s insurance regulator earlier this month announced that rates for plans sold through MNsure would rise 4.5 percent on average, Republicans, health policy experts and other critics decried the figure as bogus and misleading.
The state Commerce Department has steadfastly defended the figure — a straight average of rate changes reported by the four returning carriers to MNsure — acknowledging that some consumers will see higher or lower rate changes. State agency officials said consumers can shop around once open enrollment begins Nov. 15 “to find the best option that fits their individual health and financial needs.”
But other states, like California, Colorado and Washington, report their increases in premiums for their respective exchange plans as weighted averages.
Calculated that way, Minnesota’s figure for next year is not 4.5 percent, but 11.8 percent.”
“It’s been a tough week for North Carolina Senator Kay Hagan, who’s clinging to a razor-thin lead in her re-election fight. She chose not to attend a ‘debate’ this week, ceding an hour of statewide airtime to her surging Republican opponent, Thom Tillis. Her chair sat empty throughout the forum. What didn’t she want to discuss? Perhaps it was her decision to skip a key classified briefing on ISIS in favor of a New York City fundraiser. Or maybe it was the explosion of reports that her immediate family benefited directly from the “stimulus” law she voted for. It could have been President Obama’s endorsement of candidates like Hagan as strong supporters of his agenda in Washington; the extent of Hagan’s fealty was underscored again in yesterday’s CQ analysis of 2014 voting records:”