“How much leeway do employers and insurers have in deciding whether they’ll cover contraceptives without charge and in determining which methods make the cut?
Not much, as it turns out, but that hasn’t stopped some from trying.
Kaiser Health News readers still write in regularly about this.
In one of those messages recently, a woman said her insurer denied free coverage for the NuvaRing. This small plastic device, which is inserted into the vagina, works for three weeks at a time by releasing hormones similar to those used by birth control pills. She said her insurer told her she would be responsible for her contraceptive expenses unless she chooses an oral generic birth control pill. The NuvaRing costs between $15 and $80 a month, according to Planned Parenthood.
Under the health law, health plans have to cover the full range of FDA-approved birth control methods without any cost sharing by women, unless the plan falls into a limited number of categories that are excluded, either because it’s grandfathered under the law or it’s for is a religious employer or house of worship. Following the recent Supreme Court decision in the Hobby Lobby case, some private employers that have religious objections to providing birth control coverage as a free preventive benefit will also be excused from the requirement.”

“When the Obama administration in November 2013 decided to allow states to decide if individuals could keep noncompliant insurance plans, speculation began about what effect that decision would have on premiums and enrollment for plans that did comply with provisions of the Patient Protection and Affordable Care Act. Subsequently, the administration this March gave states the option of a maximum two-year extension into 2016.
Early indications of how many individuals opted to keep those plans have begun to emerge as have signs of the effect on premiums. As with so much else related to the ACA, the results depend on what state is being discussed.
Twenty-five states are allowing noncompliant plans to continue through 2015, which creates a continuing impact for insurers attempting to formulate premium levels in 2014, according to data compiled by America’s Health Insurance Plans, an insurer trade group. Twenty-one states are taking the full extension option, through 2016, according to AHIP.
North Dakota has seen 61% of individual policyholders of noncompliant plans from insurers Sanford Health Plan and Medica opt to retain their plans, while 92% of group policyholders chose to stay on their noncompliant plans, said Rebecca Ternes, the state Insurance Department’s deputy commissioner.”

“Research published last week in the British Medical Journal Open provides interesting insight into the cause of rising health care costs. Analysis of the study raises concerns that Obamacare could ultimately bend the cost curve up. The University of California at San Francisco research studied variations in the average charges of 10 commonly ordered outpatient blood tests in California hospitals in 2011, using data from the reports of nonfederal, general acute-care California hospitals to the California Office of Statewide Health and Planning Development.
The researchers uncovered significant and substantial variation in hospital charges across the Golden State. For example, the median charge for a basic metabolic panel (a routine laboratory test that includes such tests as sodium, potassium and glucose) was $214. Yet, for the 189 California hospitals that reported this test, the charges ranged between $35 and $7,303.”

“The Affordable Care Act gives the president’s cabinet officers sweeping powers to implement the law, but the administration managed to overreach these powers by allowing people in 36 states to illegally access health insurance subsidies.
That was the conclusion of the D.C. Circuit Court of Appeals in July.
At issue is the ability of people who sign up for coverage through exchanges established by the federal government to receive credits to reduce the cost of their health insurance.
D.C. Appeals Court Judge Raymond Randolph said the statute was quite clear in repeating seven times that subsidies are available only “through an Exchange established by the State.”
When the health law was passed, its authors apparently believed they had sufficiently cajoled the states. Jonathan Gruber, a chief architect of the law, said in early 2012, “if you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits.”
But when it became clear that most states would not be coerced, the White House called on the Internal Revenue Service to write a regulation that would allow the subsidies to flow through the default federal exchanges as well.
In Halbig v. Burwell, the D.C. court held that subsidies — as well as the coverage mandates that travel with them — apply only in states that have established their own exchanges.”

“Obamacare puts employers in a bind, two New York Federal Reserve surveys show. Employers’ health care costs continue to rise, and the health care law is driving them to hire more part-time labor, CNBC reports:
The median respondent to the N.Y. Fed surveys expects health coverage costs to jump by 10 percent next year, after seeing a similar percentage increase last year.
Not all firms surveyed said the Affordable Care Act (ACA) is to blame for those cost increases to date. But a majority did, and the percentage of businesses that predicted the ACA will hike such costs next year is even higher than those that said it did this year.
Obamacare’s higher costs will cascade down to consumers. The surveys found that “36 percent of manufacturers and 25 percent of service firms said they were hiking prices in response” to Obamacare’s effects.
The Empire State Manufacturing Survey polls New York State manufacturers, and the Business Leaders Survey polls service firms in the New York Federal Reserve District.
A June Gallup poll found that four in ten Americans are spending more on health care in 2014 than in 2013.”

“A new poll shows 69% of California voters back Proposition 45, a November ballot measure giving the insurance commissioner the power to stop excessive health-insurance rate increases..
The Field Poll released Wednesday indicates broad support statewide for Proposition 45 ahead of what’s expected to be a costly and contentious battle between consumer groups and health insurers.
Overall, 69% of registered voters said they favored the health-rate regulation measure while 16% opposed it and 15% were undecided heading into the Nov. 4 election.
The poll found that a majority of registered Democrats and Republicans in the state supported Proposition 45.
Among Democrats, 75% of those surveyed offered support while 58% of Republicans also favored it.”

“Despite the president’s assurance that “if you like your health plan, you can keep your health plan,” Obamacare caused significant disruption to people’s coverage as the health insurance exchanges prepared for their first open enrollment. Beginning October 1, 2013, insurers knew they would struggle to price policies in the exchanges accurately.
The Affordable Care Act (ACA) included three mechanisms to backstop insurers’ risks: risk adjustment, reinsurance and risk corridors. The first, risk adjustment, consists of perpetual transfers of money from unexpectedly profitable insurers to unexpectedly loss-making insurers and is — at least conceptually — necessary to mitigate risk in a market where insurers are forbidden to charge beneficiaries actuarially accurate premiums.
The other two mechanisms, reinsurance and risk corridors, were designed to protect insurers from unforeseen losses in Obamacare’s first three years, when insurers would not have enough experience to know how much risk they faced. These financial protections are critical to insurers’ ability to survive in the exchanges through the end of 2016. Both schemes persist only through the first three years of Obamacare, by the end of which its architects believed actuarial risks in the exchanges will have stabilized.”

“Last Saturday, August 16, marked the 60th anniversary of the enactment of the Internal Revenue Code of 1954, which permanently established in federal law generous tax advantages for employer-paid health-insurance premiums. Those group health benefits are excluded from employees’ taxable wages and thereby are not subject to income and payroll taxes. This tax break has been praised as a pillar of our employer-based private health-insurance system, but its age is showing. A growing list of critics agrees that the tax exclusion needs to be changed. The key questions are when and how. We should expect a significant overhaul, but not a full retirement party, within the next five to ten years.
The simplified history of the tax exclusion for health care usually begins with a 1942 ruling by the War Labor Board that allowed employers to bypass wartime wage controls by providing fringe benefits to workers. In 1943, the Internal Revenue Service issued a special ruling that confirmed employees were not required to pay tax on the dollar value of group health-insurance premiums paid on their behalf by their corporate employers. Over the next decade, a number of IRS rulings and court decisions created additional uncertainty over the full scope of the tax exclusion. When Congress codified this area of tax policy in 1954, it provided many employers and unions with even stronger incentives to sponsor group health-insurance plans.”

“Almost 7 million people can sign up for health plans under ObamaCare even before the new enrollment period begins in November, according to an advocacy group.
Enroll America, an ObamaCare enrollment group with close ties to the White House, said Wednesday that millions of adults are eligible to sign up for insurance before Nov. 15 because they have moved, gotten married, had children, lost insurance or become American citizens.”

“In April 2014, the Centers for Medicare & Medicaid Services (CMS) published detailed information on the $77 billion that 880 000 health care practitioners billed for some 6000 Medicare Part B services in 2012. This commentary by a former CMS administrator discusses how these data can be helpful, what is missing that might lead to misinterpretation, and why such transparency is here to stay.”