“When Congress returns this week, action in both chambers will mostly be a show for the voters back home ahead of the midterm election. In the House, that will include a vote on a bill to allow insurance companies to continue offering any plan that was sold in the group market in 2013.
Noticeably absent from congressional politicking in the next few weeks is the Affordable Care Act’s risk corridor program, which was, as recently as a few months ago, a major Republican criticism of the law. But that doesn’t mean the “insurer bailout” fight is dead. Republicans in both chambers are quietly working to challenge the legality and projected cost of the program. And that could tee up the issue to become a bargaining chip in the budget fights to come at the end of this year, regardless of who wins the Senate.
The Affordable Care Act’s risk corridor program runs from 2014 through 2016, and was established to encourage insurers to take a chance on covering an unknown population — the Americans who would be purchasing insurance on state and federal exchanges. The program collects funds from qualified health plans that bring in more money than they paid for medical claims, and then pays that money to plans with claims that cost more than they brought it from consumers.
But what happens if there isn’t enough money from well-performing insurers to pay all of the insurers that missed the mark? The federal government is on the hook, but where they find the money to pay those insurers is a question being debated throughout Washington. That’s because the law did not give the federal government a clear appropriation to spend money to make up for losses. And Republicans are, of course, very unlikely to give them one.”
“MADISON, Wis. — Nearly 26,000 adults who lost Medicaid coverage through Wisconsin’s BadgerCare Plus program after being kicked off earlier this year will have more time to sign up for private subsidized insurance, the federal government announced Thursday.
The U.S. Centers for Medicare and Medicaid Services said it was establishing a special enrollment period through Nov. 2 for those people to sign up under the federal exchange created under the health overhaul law.
The Wisconsin Department of Health Services estimates that about 25,800 out of 63,000 adults who lost that coverage had yet to sign up for subsidized insurance plans under the federal law.
They lost coverage after Gov. Scott Walker and the Republican-controlled Legislature tightened income eligibility for the state’s Medicaid coverage from 200 percent of poverty to 100 percent. That made the income cutoff for coverage $11,670 for an individual and $23,850 for a family of four.”
“The Cover Oregon board on Thursday moved toward keeping the health insurance exchange semi-independent rather than having state agencies take it over.
That position, if confirmed in a vote that could take place later this month, would be a significant rebuff of Gov. John Kitzhaber. In a statement Thursday, Kitzhaber said having state agencies take over the exchange “offers the lowest-risk path.”
Whatever the board’s vote, it could have ramifications for control of the exchange as well as for the November elections, political observers say.
For months the board had been debating what to recommend to the Legislature about its future. In March, Kitzhaber asked the board to examine their governance structure and determine whether changes were called for.”
“Consumers may soon find a surprise in their mailbox: a notice that their health plan is being canceled.
Last year, many consumers who thought their health plans would be canceled because they didn’t meet the standards of the health law got a reprieve. Following stinging criticism for appearing to renege on a promise that people who liked their existing plans could keep them, President Barack Obama backed off plans to require all individual and small group plans that had not been in place before the health law to meet new standards starting in 2014. The administration initially announced a transitional policy that, with state approval, would allow insurers to renew plans that didn’t comply with coverage or cost standards starting in December 2013 and continue doing so until October 2014. Then in March, the administration said it would extend the transitional policy for two more years, meaning that some people will be able to hang onto their non-compliant plans through 2017.”
“With the second open enrollment period of the health insurance marketplaces approaching, this analysis provides an initial look at premium changes for marketplace plans for individuals in 15 states and the District of Columbia that have publicly released comprehensive data on rates or rate filings for all insurers.
The analysis examines premium changes for the lowest-cost bronze plan and the two lowest-cost silver plans in 16 major cities. The second-lowest cost silver plan in each state is of particular interest as it acts as a benchmark that helps determine how much assistance eligible individuals can receive in the form of federal tax credits. The findings show that in general, individuals will pay slightly less to enroll in the second-lowest cost plan in 2015 than they did in 2014, prior to the application of tax credits.
Although premium changes vary substantially across and within states, premium changes for 2015 in general are modest when looking at the low-cost insurers in the marketplaces, where enrollment is concentrated. While the analysis provides an early look at how competitive dynamics may be influencing health insurance premiums, it is important to bear in mind that the overall picture may change as comprehensive data across all fifty states becomes available.”
“In 2002, in a modification of the primary healthcare information privacy rule under the Health Insurance Portability and Accountability Act, HHS removed patient consent as a requirement for the release and disclosure of patient information for most common uses. In so doing, HHS gave a regulatory green light to electronic health data disclosures.
Twelve years later, it looks as if Apple is laying down a big bet in the opposite direction by placing consent-management restrictions on developers who plan to use its HealthKit mobile application platform, which is expected to be part of its new operating system to be released later this month, according to published reports.
According to the Guardian, which quotes as its primary source an article in the Financial Times, Apple has informed developers that they “’must not sell an end-user’s health information collected through the HealthKit APIs to advertising platforms, data brokers or information resellers.””
“It’s not a news flash that health insurance can be complex and confusing. But the health insurance maze can be a problem, especially if you have never had health insurance before or have not had it for a long time. That’s the case for about half of the uninsured and for many people enrolling in the new insurance marketplaces set up under the Affordable Care Act.
37% of enrollees don’t know the amount of their deductible. The deductibles in the plans sold on the exchanges are large; on average $2,300 for single coverage in the most popular plan, a Silver plan. For many people their deductible will be as important to their family budgets and their ability to get health care as the premium they pay, especially if they get a premium subsidy as most do in the exchanges. If people don’t understand their deductibles and copays they may pick a plan based solely on the premium and be in for a nasty surprise when they begin to use care and their deductible hits. It can also be important to know if services such as some physician visits and tests or generic drugs are exempt from the deductible.
Speaking of the subsidies, 46% of enrollees in the new insurance marketplaces say they’re getting a subsidy, when official numbers indicate about 85% actually get them. And even among those who know they’re receiving a subsidy, 47% don’t know the amount of the subsidy. A political implication is that many people getting help from the ACA don’t know it.
Many enrollees also don’t grasp basic insurance terms. A study of people eligible to enroll in the marketplaces showed that many were not confident in their understanding of a premium (36%), deductible (31%), copayment (28%), coinsurance (48%), maximum annual out-of-pocket spending (38%), provider network (36%), covered services (35%), annual limits on services (39%) or excluded services (40%).”
“The District of Columbia U.S. Circuit Court of Appeals in Washington on Thursday said the full 11-member court will rehear (PDF) the controversial case that ruled Americans could not receive subsidies to help pay for plans on federally run health insurance exchanges. Oral arguments will begin Dec. 17.
The court’s decision to rehear the case en banc, which experts said is rare for the D.C. appellate court, vacates the judgment issued earlier this summer. On July 22, a three-judge panel ruled 2-1 in Halbig v. Burwell that the Patient Protection and Affordable Care Act forbade people with lower incomes from receiving tax subsidies from insurance marketplaces run by the federal government, effectively making those subsidies illegal in 36 states.
Opponents of the Affordable Care Act greeted the D.C. court’s initial ruling with praise, saying the judges upheld the text of the law. The law’s supporters, however, argued the court read the text too narrowly and applied an unreasonable and inaccurate interpretation of exchange subsidies.
The July ruling dealt a fresh blow to President Barack Obama’s healthcare law, which relies on the insurance subsidies to make coverage more affordable for millions of people. However, the Obama administration vowed at the time to petition for a full court review of the decision.”
“Unhappy with the choices her insurance broker was offering, Denver publishing company owner Rebecca Askew went to Colorado’s small business health insurance exchange last fall. She found exactly what she’d been hoping for: affordable insurance options tailored to the diverse needs of her 12 employees.
But Askew is in a tiny minority. Only 2 percent of all eligible businesses have checked out so-called SHOP (Small Business Health Options Program) exchanges in the 15 states where they have been available since last October under the Affordable Care Act. Even fewer purchased policies.
In November, three more state-run SHOP exchanges are slated to open, and the federal government will unveil exchanges for the 32 states that chose not to run their own.
SHOP exchanges were supposed to open nationwide on Oct. 1, the same day as exchanges offering health insurance for individuals. But the Obama administration postponed the SHOP launch, citing the need to fix serious technical problems with the exchanges for individuals, which it said were a higher priority.”
“DEARBORN, Mich.–Signing people up for health insurance is the easy part of Rawha Abouarabi’s job ministering to immigrants and Arab Americans in this manufacturing hub along the Rouge River.
Nagat Sahouba, a medical assistant for the Arab Community Center for Economic and Social Services, takes down a client’s information for an appointment in the center’s clinic in Dearborn, Mich. on Aug. 7, 2014 (Photo by Marissa Evans/KHN).
But many of those she’s enrolled are surprised and indignant when they go to the doctor and are asked to a pay a bill— perhaps a copayment. They insist they’ve already paid their monthly insurance premium.
“They call us and say, ‘it’s a scam’,” says Abouarabi, an insurance navigator for the Arab Community Center for Economic & Social Services (ACCESS), a nonprofit agency that specializes in helping the largest Arab-American population in any U.S. city.
That’s just one example of the confusion immigrants face as they try to navigate the U.S. health care system. Even after signing up for insurance through the Affordable Care Act, advocates find that explaining to clients that they will still have to pay out of their own pockets each time they go to the doctor or get lab tests requires more than translating words like “premium” and “deductible” for non-English speakers.
“This whole concept of insurance doesn’t exist in the Eastern world,” said Madiha Tariq, public health manager for ACCESS. “People are always confused about the health care system when they come to this country.””