Articles on the implementation of ObamaCare.
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.
For tax year 2015, millions of Americans will be getting a new tax form related to health care reform measures.
Will you know what to do with yours when it arrives?
The Affordable Health Care Act mandated three new tax forms to be used as a kind of proof of insurance so taxpayers may avoid paying a penalty for failure to be covered. They are:
- Form 1095-A, sent to those who purchase health insurance on government marketplaces.
- Form 1095-B, sent to employees of businesses with fewer than 50 full-time employees
- Form 1095-C, sent to employees of businesses with more than 50 full-time employees
Since the Affordable Care Act was signed into law on March 2010, the Obama administration has changed the law 43 times without Congressional approval. The Galen Institute has been keeping track of these administrative changes, which you can find here.
Apparently another illegal administrative action, which will cost the U.S. Treasury $3.5 billion, can be added to the list. Late last Friday, and conveniently before a long weekend, the Centers for Medicare and Medicaid Services announced in a guidance document it would have $7.7 billion in reinsurance payments to cover the losses Exchange plan insurers incurred in 2015. But CMS is not entitled to $3.5 of the $7.7 billion it is giving away.
A federal appeals court in Atlanta on Thursday upheld a contraceptive mandate included in the president’s health care law but is delaying the implementation of its ruling until the U.S. Supreme Court can weigh in on the issue.
A three-judge panel of the 11th U.S. Circuit Court of Appeals ruled 2-1 to reject challenges to the mandate in a single opinion addressing two separate cases, one filed by nonprofit organizations affiliated with the Catholic Church in Georgia and the other by Catholic broadcaster Eternal Word Television Network in Alabama.
The organizations had argued the mandate and a related rule against those entities would violate the Religious Freedom Restoration Act of 1993, which prohibits the government from imposing a substantial burden on a person’s religious practice.