Articles on the implementation of ObamaCare.
In a major win for the industry, health insurers will not be forced to have minimum quantitative standards when designing their networks of hospitals and doctors for 2017, nor will they have to offer standardized options for health plans.
The CMS released a sweeping final rule (PDF) Monday afternoon that solidifies the Affordable Care Act’s coverage policies for 2017. The agency proposed tight network adequacy provisions and standardized health plan options in late November, which fueled antipathy from the health insurance industry.
Monday’s rule relaxes those aggressive proposals, a move that likely will raise the ire of consumer groups that have pushed for stronger insurance protections for patients. It does, however, include some victories for transparency advocates. The federal government, for example, will now have to publish all changes to premium rates, not just increases that are subject to review.
Co-ops created under ObamaCare reported net assets despite losing millions because they used an accounting trick approved by the Centers for Medicare and Medicaid Services.
Tax filings for 18 co-ops, including nine that collapsed in 2015, also revealed that co-op CEOs were paid handsomely before many had to shut down.
In July 2015, the Centers for Medicare and Medicaid Services amended its agreement with co-ops, allowing them to list $2.4 billion in loans they received from taxpayers as assets.
Right now, the New Hampshire House is considering reauthorizing Medicaid expansion under ObamaCare. Doing so would be a big mistake that our state simply cannot afford to make.
In 2014, New Hampshire expanded its Medicaid program under the Affordable Care Act. Previously, to qualify for Medicaid a person needed to be both poor and medically needy (pregnant women, children or disabled). Under Medicaid expansion, a person needs only to be below 138 percent of the federal poverty level. That means that able-bodied adults, even above the poverty line, would have taxpayers buy health insurance for them.
The measure that was passed in 2014 ends on Dec. 31, 2016. That means that if the program is not reauthorized, eligible able-bodied adults would no longer have taxpayer-funded health insurance.
The reauthorization bill currently sits before the House Finance Committee to make sure our Medicaid policy is on a solid financial footing. Given the total size of the program – close to $500 million per year – this seems like a prudent step.
Transitional Reinsurance is a key part of the Affordable Care Act. It’s a component of a set of provisions designed to lure private health insurers into selling insurance on various Exchanges. Without continued private insurer participation, Obamacare as we know it falls apart. Congress thought it needed lures (1) because health insurers did not have much experience with the medical expenses of the population they would be insuring and (2) because Congress was outlawing health insurers’ favorite technique for staying profitable: pricing policies according to the predicted medical expenses of the insured. Congress set the hook by giving insurers selling on the Exchanges something for free that they otherwise would have to pay for: reinsurance. With “Transitional Reinsurance” The federal government would itself pick up the bill three years for much of the expense of insureds who ended up having high medical expenses.
But, as with lunch, there is really no such thing as free reinsurance.
A Centers for Medicare and Medicaid Services official said Thursday she could not say how many of the remaining 11 insurance co-ops created under the Affordable Care Act are profitable.
Eight of the 11 remaining co-ops are on corrective action plans this year that detail operational issues and ways to correct them, Mandy Cohen, CMS’s chief operating officer and chief of staff, said at a House Oversight and Government Reform Health Subcommittee hearing. She also said she could not tell lawmakers at the hearing which of the remaining co-ops are meeting their enrollment projections.
Consumers who try to sign up for insurance after the Obamacare open enrollment period will soon need to submit proof that they are eligible for most special enrollment periods, federal health officials announced Wednesday.
This new confirmation process, which is expected to start in the next few months, will only affect those living in the 38 states that use the federal Healthcare.gov site.
It addresses complaints from insurance companies that the Centers for Medicare and Medicaid Services was allowing too many people to buy insurance after the open enrollment deadline passed. This, insurers said, left them with many consumers who waited until they were sick to sign up and then dropped coverage after they received treatment. And the companies claim that created a sicker-than-expected pool of customers that was contributing to the losses on Affordable Care Act exchange plans.
Leaders of some health cooperatives set up under the Affordable Care Act said it would be hard for the Obama administration to recoup more than $1 billion in federal loans made to some of the organizations that are now defunct, because most of the money has been spent.
A group representing existing co-ops, as well as leaders of some of the organizations, said there is little of the federal loan money remaining and some of what is left is needed to pay providers whose bills have yet to be paid. Obama administration officials have said they plan to use every available tool to recoup the federal loans, including legal action.
Thousands of doctors, hospitals and other providers in some states still haven’t been paid for health services they provided to members insured by the co-ops, which are organizations set up under the health law to offer health insurance to consumers and cut costs by giving established insurers more competition.
A response to questions from Senator John Cornyn (R-TX) about federal spending on state-based ObamaCare exchanges reveals the improper spending of one million dollars in Arkansas. The states setting up their own exchanges have spent more than $3.2 billion in federal funds, and many of those states have presided over failed exchanges and have opted to have their citizens routed to the federal healthcare.gov ObamaCare exchange.
Responding to Sen. Cornyn, Centers of Medicare and Medicaid Services Acting Administration Andrew Slavitt wrote, “as part of CMS’s routine federal oversight of (exchanges), CMS found that the Arkansas SBM spent approximately $1 million of the state’s federal grant funding for activities that are not allowed under regulations.”
In a recent letter addressed to Senator John Cornyn (R-Texas), ObamaCare chief Andy Slavitt said the federal government will “recover its fair portion” of funds in the event a failed ObamaCare state exchange reaches a settlement with contractors.
Given that the federal government funded the overwhelming majority of state exchange projects with $5.5 billion in taxpayer funds, “fair portion” should be close to 100 percent.
Recently, Maryland reached a $45 million settlement with a contractor stemming from its state exchange debacle. But despite financing the Maryland exchange to the tune of nearly $200 million the federal government will receive only 70 percent of funds from the settlement.
Funding a problem doesn’t solve a problem. There are ways to make health care more affordable and accessible with less government dependence. For starters, Congress should seriously reconsider the way the program is financially structured so states can be granted more flexibility to devise ways that can improve the value Medicaid brings to its beneficiaries.
The other component involves reducing regulation to make medical care more affordable, like repealing Certificate of Need, permitting mid-level providers to practice within their full scope of authority, exercising right-to-try laws, reducing the number of health insurance benefit mandates, or changing the federal tax code to allow the direct primary care market to expand.