Articles on the implementation of ObamaCare.
The Obama administration, responding to consumer complaints, says it will begin rating health insurance plans based on how many doctors and hospitals they include in their networks.
At the same time, the maximum out-of-pocket costs for consumers under the Affordable Care Act will increase next year to $7,150 for an individual and $14,300 for a family, the administration said. Consumer advocates said those costs could be a significant burden for middle-income people who need a substantial amount of care.
Under new rules to be published Tuesday in the Federal Register, insurers will still be allowed to sell health plans with narrow networks of providers. But consumers will know in advance what they are getting because the government will attach a label indicating the breadth of the network for each plan sold on HealthCare.gov.
Six of the 32 states implementing the Affordable Care Act’s Medicaid expansion to date have done so through Section 1115 waivers. Using these waivers, the Centers for Medicare and Medicaid Services has approved terms that extend beyond the flexibility provided by federal law. Section 1115 waivers authorize research and demonstration projects that, in the view of the Health and Human Services Secretary, further the purposes of the Medicaid program. The ACA implemented new requirements for these waivers, including that states must have a publicly available, approved evaluation strategy. States also must submit an annual report to HHS that describes the changes occurring under the waiver and their impact on access, quality, and outcomes.
State Medicaid agencies say Congress’ decision to suspend the Affordable Care Act’s tax on health insurers for one year is a good first step, but they are pushing for its permanent repeal.
While most private health insurance plans have had to pay the tax themselves, states that contract with Medicaid managed-care plans have had to cover the premium tax to ensure that the health plans receive actuarially sound rates. Thirty-eight states and the District of Columbia contract with Medicaid managed-care plans.
Congress’ decision to suspend the Affordable Care Act’s tax on health insurers for one year will cost the government $13.9 billion, funding that normally would go to cover subsidies for low-income enrollees and other functions of the law.
The CMS, therefore, expects insurance companies to keep their premiums in check when they file 2017 rates this spring. The hope is the one-year tax reprieve will put a ceiling on premium increases and push savings to consumers instead of into the coffers of health insurers.
“Because the fee is not being collected for the 2017 fee year, administrative costs for plans in all impacted markets are expected to be adjusted appropriately to account for the moratorium,” the CMS said in a document posted Monday.
While many Americans are obsessively following the presidential primary campaign, health policy experts are concerned about little-noticed Republican primary contests for state legislative seats that could determine the fate of Medicaid expansion in Arkansas and other states.
In Arkansas, Tuesday’s elections include several primary contests pitting Republican state lawmakers who voted for Medicaid expansion to low-income adults against GOP primary challengers who promise to end the state’s coverage expansion. Republican Gov. Asa Hutchinson needs votes from 75% of the GOP-controlled Legislature to win approval for his conservative changes in the state’s Medicaid expansion program, or else the expansion will end this year. So he can’t afford to lose any expansion allies.
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.