The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers
“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.””
“If you get health insurance through your workplace, you’ll probably have a chance this fall to make important decisions about your coverage and costs.
Because many corporate health plans hold their annual open-enrollment periods in October and November, many employees can expect to get a packet of benefits, or instructions for making elections online, as well as updates on changes to their plans required by the Affordable Care Act. Some 55% of Americans have employer-based coverage, according to Mercer, a human-resources consultant.
“From the employee perspective, if there is any year to pay attention to the information, this is the year,” says Brian Marcotte, president and chief executive of the National Business Group on Health, a nonprofit representing large employers.
Starting next year, one change could be an ACA provision requiring some large employers—generally those with 50 or more full-time or equivalent workers—to offer affordable, adequate coverage to employees working more than 30 hours a week.”
” If you got health coverage through President Barack Obama’s law this year, you’ll need a new form from your insurance exchange before you can file your tax return next spring.
Some tax professionals are worried that federal and state insurance marketplaces won’t be able to get those forms out in time, creating the risk of delayed tax refunds for millions of consumers.
The same federal agency that had trouble launching HealthCare.gov last fall is facing the heaviest lift.
The Health and Human Services Department must send out millions of the forms, which are like W-2s for people getting tax credits to help pay health insurance premiums.
The form is called a 1095-A, and it lists who in each household has health coverage and how much the government paid each month to subsidize their premiums. Nearly 5 million people have gotten subsidies through HealthCare.gov.”
“Consumers getting government subsidies for health insurance who are later found ineligible for those payments will owe the government, but not necessarily the full amount, according to the Treasury Department.
The clarified rule could affect some of the 300,000 people facing a Sept. 5 deadline to submit additional documents to confirm their citizenship or immigration status, and also apply broadly to anyone ultimately deemed ineligible for subsidies.
First reported by the newsletter Inside Health Policy on Thursday, the clarification worries immigration advocates, who say many residents are facing website difficulties and other barriers to meeting the deadline to submit additional details. Those who don’t know about the deadline, or can’t meet it because of glitches, could be deemed ineligible for subsidies and lose their coverage.
“We’re very concerned about the implications of this on hundreds of thousands of low-income individuals who are likely eligible, but have encountered significant difficulties with the website, uploading or sending documents,” said Mara Youdelman, managing attorney at the National Health Law Program.
If found ineligible, residents could owe thousands of dollars.”
“When Congress passed the Affordable Care Act, it required health insurers, hospitals, device makers and pharmaceutical companies to share in the cost because they would get a windfall of new, paying customers.
But with an $8 billion tax on insurers due Sept. 30 — the first time the new tax is being collected — the industry is getting help from an unlikely source: taxpayers.
States and the federal government will spend at least $700 million this year to pay the tax for their Medicaid health plans. The three dozen states that use Medicaid managed care plans will give those insurers more money to cover the new expense. Many of those states – such as Florida, Louisiana and Tennessee – did not expand Medicaid as the law allows, and in the process turned down billions in new federal dollars.
Other insurers are getting some help paying the tax as well. Private insurers are passing the tax onto policyholders in the form of higher premiums. Medicare health plans are getting the tax covered by the federal government via higher reimbursement.”
“From Halbig to Sovaldi, this summer was a busy one for health policy and politics. We’ve made it easy to catch up, collecting all of the top stories you clicked on over the past few months. Together, they tell a story about the state of healthcare in the U.S., and offer clues as to where things may be headed when Congress returns in the fall.
Among them: The political battle over Obmacare has become more complicated for Republicans since the government cleaned up the Healthcare.gov mess, and with midterm elections around the corner, the focus will be on how much either party continues to attack or ignore the law. There are policy, legal and business matters to be settled as well – the employer mandate is under attack from the left and the right, the courts have been a wildcard for the health law to this point and could continue to be so, and employers and employees are finding themselves wading through the on-the-ground impacts of the law. That doesn’t even get to our top three storylines of the summer, so be sure to click through to find out what tops the list.”
“Thursday’s announcement that Pennsylvania will expand its Medicaid program brings the country one state closer to the original expansion outlined under Obamacare. But because of the Supreme Court’s 2012 decision making the expansion a voluntary program, there are still 23 states that haven’t expanded public health insurance to all of their low-income residents.
The expansion in Pennsylvania will add about 500,000 low-income to adults to the Medicaid rolls. According to numbers from the Kaiser Family Foundation, about 281,000 of those people were falling into what’s known as the “coverage gap”— people who don’t qualify for Medicaid but also don’t get subsidies for purchasing insurance on their own, either. About 4.5 million people across the country fall into this coverage gap, according to Kaiser.”
“When the Affordable Care Act’s insurance exchanges reopen enrollment this fall, many companies will look to tap the growing prominence of Hispanic consumers. Healthcare companies that use technology wisely and partner with brands already familiar to Hispanics will have the advantage in reaching the nation’s fastest-growing demographic group.
Although the US Hispanic pocketbook packs a punch–$1.2 trillion in purchasing power in 2013, more than any other ethnic group1 –the health industry has yet to win the Hispanic consumer and their dollar. More than 10 million Hispanics could gain health insurance coverage under the ACA through Medicaid expansion and the marketplaces, which are entering year two. Yet, Hispanics only accounted for 7.4%–about 400,000–of more than 5 million enrollees in the federal marketplaces last year.2,3
For businesses aiming to succeed in the new health economy, Hispanics represent unparalleled growth opportunities. Some firms are already developing focused strategies that cater to this important group—who are mobile savvy, cost conscious, and prefer receiving care in alternative settings.”
“The widely accepted view among policymakers in Washington, D.C. is that even if President Obama’s health care law is currently more unpopular than ever, by the time 2016 rolls around, it will be an immovable object, impossible to wholly repeal.
In past columns for The Morning Consult, I have argued this is an incomplete picture of the politics of the issue, one which underestimates the Republican base’s dedication to repeal, and the necessity of Republican candidates to respond to that desire.
You could assume that the continued unpopularity of Obamacare would play to Republicans’ advantage within the battle over health care policy, and that’s certainly correct at the moment. The fact that a Democratic Senator touting his support for Obamacare (albeit without naming which law he voted for) is national news is an indication of that. Had the politics of the Affordable Care Act played out as most Democrats anticipated, every candidate up for re-election would be loudly trumpeting their support for it.
So in the short-term, the law plays into the hands of Republican critics, who have plenty of easy targets and little need to propose a comprehensive reform. But what about what comes after 2016, assuming a Republican presidency but lacking 60 votes in the Senate? At that point, Obamacare’s political toxicity may actually hamper efforts to achieve pro-market reforms.
Consider Avik Roy’s recent proposal, Transcending Obamacare, which is possibly the most comprehensive proposal for health reform offered by a conservative. Not content to merely focus on replacing Obamacare, Roy’s plan relies heavily on the expansion of the existing private insurance marketplace as a replacement for the Great Society, shifting individuals away from Medicare and Medicaid and the VA, and toward private insurers.”
“The Republican fight against Medicaid expansion is far from over, but there are fewer opponents than there used to be.
The expansion of the government health insurance program was originally supposed to be mandatory under the Affordable Care Act, but the Supreme Court made it optional as part of a landmark decision on the law in June of 2012.
In the wake of the decision, Republican governors flocked to announce they were declining to expand coverage.
As of 2014, 19 states — 18 of which are led by Republican governors — have declined outright to expand coverage, but some former holdouts are beginning to come to terms with expansion.
This week, Pennsylvania formally agreed to terms with federal regulators, raising the number of states that have expanded coverage for low-income residents under Obamacare to 27. Pennsylvania is the ninth state led by a Republican governor to expand Medicaid.:”