Articles on the implementation of ObamaCare.
The third open enrollment period (OEP) for the public exchanges concluded in January. Many carriers—both early-OEP entrants and “wait-and-see” latecomers—believed this new market would achieve stability and sustainable margins in its third year. However, recent events— including carrier turnover (both entrances and exits), plan terminations, and pricing volatility—suggest the market is still in flux.
One reason for the flux is the variability of individual market financial performance many carriers have disclosed publicly. For some carriers, significant losses are causing marked changes in enterprise-level capital, cost structures, and strategy. Early indications of 2015 performance suggest aggregate negative margins may have doubled; to date, however, only 86% of carriers have released preliminary data publicly. We anticipate that our estimates will evolve as more information is released, such as final 3R results and rebates, as well as 2015 claim run-out and adjustments. Whether carriers’ performance in the individual market will improve in 2016 remains unclear.
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District Court Judge Rosemary Collyer has ruled for Congress in House v. Burwell, a case challenging the authority of the executive branch to pay Obamacare subsidies for which no money has been appropriated.
These are not the highest-profile subsidies; they’re something called the cost-sharing reduction, which lowers the deductibles and out-of-pocket expenses for families buying silver plans who make less than 250 percent of the poverty line. The federal government has paid the insurers a lot of money that wasn’t appropriated, and the House has sued to stop that.
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Health insurance customers in a growing number of mostly rural regions will have just one insurer’s plans to choose from on the ObamaCare exchanges next year as some companies pull out of unprofitable markets. The entire states of Alaska and Alabama are expected to have only one insurer on the health law’s signature online marketplaces next year, according to state regulators. The same is expected to be true in parts of several other states, including Kentucky, Tennessee, Mississippi, Arizona and Oklahoma, state regulators said.
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Insurers and hospitals can’t discriminate against patients because of their gender identity under the Affordable Care Act, federal officials said Friday, but patient groups complained the rule doesn’t go far enough.
The Department of Health and Human Servicesfinalized a rule that prohibited discrimination in health care based on a long list of characteristics ranging from race to pregnancy, gender identity and “sex stereotyping.”
It doesn’t mean insurers have to cover all treatments associated with gender transitioning but they just can’t outright deny them either. But the rule doesn’t go far enough in clarifying what is discrimination, some say.
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- 40% eligibility for financial assistance,
- 15% how to project income,
- 11% account creation issues, and
- 6% changes in circumstances.
The researchers say that the questions paint a picture of complex eligibility and enrollment processes, and could lend valuable insight in preparation for the fall open enrollment period, beginning November 1.
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The Obama administration’s continuing efforts to rewrite and re-interpret the legal requirements of the Affordable Care Act (ACA) hit a new roadblock in federal district court yesterday. Judge Rosemary M. Collyer ruled that advance payments to insurers of cost-sharing reduction (CSR) subsidies for certain lower-income enrollees in Obamacare’s health insurance exchanges were never appropriated by Congress. Oops. She therefore enjoined any further reimbursements until a valid appropriation is in place, but the judge also issued a stay of that injunction pending any appeal by the parties.
The decision in United States House of Representatives v. Sylvia Matthews Burwell, et al. is a big win for House Republicans, other Obamacare opponents, and the rule of law. It also signals at least the outer limits of the Obama administration’s repeated efforts to stretch implementation of the 2010 law far beyond legal norms and the plain meaning of the ACA’s statutory text.
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The Department of Justice will appeal a federal judge’s ruling in a lawsuit from House Republicans against the Obama administration.
A spokesperson did not respond to an inquiry asking when the department would file an appeal. A district judge for the District of Columbia ruled yesterday that the administration was improperly funding cost-sharing subsidies under the Affordable Care Act.
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A federal judge’s decision Thursday that the Obama administration unconstitutionally spent money to pay for part of the Affordable Care Act may not disrupt health plans or beneficiaries right away. But the fresh uncertainty immediately delivered a blow to the share prices of hospitals and health insurers.
House Republicans alleged in a lawsuit that the administration illegally spent money that Congress never appropriated for the ACA’s cost-sharing provisions. Those provisions include reduced deductibles, copayments and coinsurance many Americans receive, depending on income, for plans purchased through the ACA’s insurance exchanges.
U.S. District Court Judge Rosemary Collyer agreed with House Republicans on Thursday, writing that appropriating the money without congressional approval violates the U.S. Constitution.
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Today, a federal judge sided with the House of Representatives in a major lawsuit challenging executive branch overreach,ruling that the Obama administration has been making illegal payments to health insurance companies participating in the Affordable Care Act (ACA) exchanges. U.S. District Court Judge Rosemary Collyer found that Congress never appropriated the billions of taxpayer dollars that the administration has delivered to insurers through the ACA’s cost sharing reduction (CSR) program. Today’s decision is a victory for the rule of law. It may also give insurers pause about their future participation in the exchanges.
The issue raised by the House of Representatives lawsuit is that the executive branch cannot spend money without a congressional appropriation since Article I of the Constitution gives Congress the power of the purse. Today, Judge Collyer agreed, writing “Paying out [cost-sharing subsidies] without an appropriation violates the Constitution. Congress is the only source for such an appropriation, and no public money can be spent without one.”
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A federal judge on Thursday ruled the Obama administration has been improperly funding an Obamacare subsidy program, a huge win for the House of Representatives’ lawsuit against the White House.
The judge said that the program can continue, pending appeal. The ruling, if it stands, could be a significant financial setback for the millions of low-income Americans who benefit from the cost-sharing subsidies, which help people pay for out-of-pocket costs like co-pays at the doctor’s office.
Congress authorized the program but never actually provided the money for it, wrote U.S. District Court Judge Rosemary M. Collyer, a George W. Bush appointee.
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