Articles on the implementation of ObamaCare.
Breaking with normal tradition, we’re going to open this week’s update with national trends before moving into updates at the federal and state levels. This week there was an interesting report from the Kaiser Family Foundation that estimated that 50 percent of households receiving financial assistance to purchase private health insurance on the Marketplaces will have to return a portion of that subsidy when they file their tax returns as part of the tax credit reconciliation process. Repayments will, in most cases, be deducted from an enrollee’s refund check and the Kaiser report estimates that the average repayment will be $794. Roughly seven percent of enrollees could owe a repayment of between $2,000 and $5,000 and two percent could have to repay more than $5,000. A slightly smaller percentage of households, 45 percent, are estimated to receive additional money with their tax refund because they received underpayments in tax credits, with the average refund estimated to be $773. Kaiser’s report comes the same week as an unrelated but equally insightful analysis from Avalere found that for Open Enrollment 2 (OE2), ACA Marketplaces were primarily successful in enrolling lower-income persons eligible for subsidized coverage. The report found that as a person’s income went up, they were less likely to enroll in ACA coverage through a Marketplace, with only two percent of persons eligible for Marketplace coverage, but earning more than the amount to receive a subsidy, enrolled in a plan through a Marketplace.
With many Marketplaces and the Federally-facilitated Marketplace currently offering a Special Enrollment Period (SEP) for those currently uninsured who did not have health coverage in 2014 and are subject to the “shared responsibility payment” when they file their 2014 taxes, there have been few updates on how many eligible persons are taking advantage of this opportunity to gain coverage. However, over the weekend Mark Ciaramitaro, a vice president of health-care enrollment services at H&R Block, told the Wall Street Journal “that a significant percentage of taxpayers whose household members were not covered for at least a portion of 2014 are opting” to pay the penalty for not having coverage and not demonstrating an interest in signing up for 2015 coverage.
The Affordable Care Act, signed by President Obama five years ago this week, sparked a host of changes. For some workers, the law’s legacy amounts to fewer hours of paid work.
The law’s requirement that larger employers provide affordable insurance to workers putting in 30-plus hour weeks has led some companies to cap the number of hours employees can log. A new survey out Tuesday from the Society for Human Resource Management finds that 14% of employers have cut back on hours for part-time employees, and an additional 6% plan to do so. The survey, which included more than 740 human resources professionals, found that a small subset of companies were considering reducing hours for full-time employees too.
Firms are playing around with how they classify and schedule workers, but the strategy comes with risk. James Napoli, a partner with Seyfarth Shaw LLP who helps employers comply with the ACA, says he’s seen an uptick in audits focused on compliance with the health care law by the Department of Labor and the Internal Revenue Service. The audits, which began about three years ago, are starting to become broader, more frequent and more serious, he said.
Six Democratic senators and one independent have asked the Department of Health and Human Services to a delay a new rule that would likely force small businesses to pay more for employee health insurance under the Affordable Care Act, aka Obamacare. The senators warn that if the administration goes ahead with the change it would be “particularly harmful and disruptive” to small businesses.
Starting in 2016, the Obamacare change will require businesses that employ between 51-100 people to purchase insurance in what the government defines as the “small group market,” rather than the market for large group plans. The senators warn that the change will inflate health care costs for those businesses.
“[T]hey could experience higher premiums, less flexibility, and new barriers to coverage. We therefore encourage you to delay the effective date in the definition change for two years so the market can more smoothly transition to the new rules,” the senators wrote in the March 12 letter to HHS Secretary Sylvia Burwell.
During a 2014 Valentine’s Day meet-up with House Democrats, President Obama thanked them for their unstinting support of the Patient Protection and Affordable Care Act. “I think,” he said, “10 years, five years from now, we’re going to look back and say this was a monumental achievement.”
Well, the president’s health care law marks its fifth anniversary this week. And most Americans are not, in fact, looking back and saying the law enacted in 2010 – with not one Republican vote in either the House or Senate – was a monumental achievement.
Indeed, in an NBC News/Wall Street Journal poll this month, a 44-34 plurality of respondents thought Obamacare a “bad idea.” And a 62-22 percent majority said that what they had seen, read or heard in recent weeks about the Affordable Care Act had made them “less confident” about the law.
Some suggest the public’s misgivings about Obamacare are almost entirely attributable to GOP opposition to the law. In a statement Monday, Democratic National Committee Chairwoman Debbie Wasserman Schultz noted that “Republicans have voted more than 50 times to repeal or undermine this critical law.”
Looking closer, the 6.3 million-person enrollment drop in fully insured employee plans represents a sudden 10 percent decline in a market that previously had been eroding by about 1 percent to 3 percent a year. In contrast, the 1.4 million more individuals in self-insured plans equates to enrollment growth of about 1.5 percent in a market that, prior to Obamacare, was growing at about 1 to 3 percent a year—putting that uptick solidly within the pre-Affordable Care Act trend range.
Thus, the data indicates Obamacare likely was responsible for a significant additional decline in fully insured employer group coverage. But, with respect to another anticipated effect—the expectation that more employers will shift to self-insured plans to escape Obamacare’s costly benefit mandates—the data does not indicate that is yet occurring to any noticeable extent. The modest enrollment increase in self-insured employer plans could well be the result of other factors, the most likely being increased job creation as the economy continues to recover from the last recession.
Taken together, the administrative data tell us that the number of Americans with health insurance coverage increased by around 9.7 million individuals during 2014—not the 14.1 million estimated by Health and Human Services.
The Congressional Budget Office’s new report shows updated cost projections for the insurance coverage expansion in the Affordable Care Act. With the debate over the ACA remaining so intensely polarized, advocates moved aggressively to spin this routine update as reflecting favorably on the law. A front-page article in the Washington Post referred to the new findings as showing “savings,” quoting a supporter as saying, “I can’t see how people can continue to say . . . that Obamacare had no cost containment in it.” Such comments in the wake of CBO’s update are flawed interpretations of the new estimates and what they signify. The following explains what CBO has actually projected: basically that the ACA will do less to expand coverage than previously estimated.
Five years after President Obama signed the Affordable Care Act, the White House claims the law is working even better than imagined, but one of its leading critics says every major promise is now proven untrue and costs will keep going higher and higher unless we change course.
On March 23, 2010, President Obama signed the landmark Patient Protection and Affordable Care Act, also known as Obamacare, into law. It happened after a fierce debate on the House floor just a few days earlier and a controversial move by Senate Democratic leaders to pass changes by a simple majority since they did not have the votes to do it through regular order.
The law took full effect in 2014, following a disastrous roll-out of the federal health-care exchange website in October 2013. But for those who warned against the law before its passage, the contents of the law are far more troubling than the major technical problems that bogged down the exchange.
“People have learned on a very personal level how they were lied to in the passage of this law. They’ve lost their doctor. They’ve lost their health plan. Their costs are going up. Many people have lost jobs and certainly hours as a result of it. Small businesses have felt a huge impact, said Galen Institute President Grace-Marie Turner. “It’s been a tremendous drain on the economy, and very few if any of those original promises were met.”
Turner is a longtime veteran of Washington health-care policy debates. She was at the forefront of the effort to stop the Clinton administration’s attempt to overhaul the health-care system in 1993 and is still fighting to roll back Obamacare.
She was in the House chamber in March 2010 during the final, intense moments of the debate.
ObamaCare is celebrating its fifth anniversary, but few Americas are cheering.
The Real Clear Politics average of the latest major opinion polls about the health law shows that 52.5% oppose it and only 42% approve. The 10.5% spread is identical to the average of polls taken when the law was signed five years ago. Approval numbers never have topped disapproval numbers since the law was enacted. It is not getting more popular and it is not settled law, as President Obama claims.
President Obama is touting the increased number of people who have health insurance as a result of the law. According to Gallup, the uninsured rate among U.S. adults averaged 12.9% in the fourth quarter of last year. The uninsured rate was 14.4% the year before the health law passed, also according to Gallup.
So our health sector has been thrown into turmoil, millions of people have lost their private health plans, $1 trillion in new and higher taxes have been imposed on individuals and businesses – and the uninsured rate has dropped a net of 1.5%.
Complying with the health care law is costing small businesses thousands of dollars that they didn’t have to spend before the new regulations went into effect.
Brad Mete estimates his staffing company, Affinity Resources, will spend $100,000 this year on record-keeping and filing documents with the government. He’s hired two extra staffers and is spending more on services from its human resources provider.
The Affordable Care Act, which as of next Jan. 1 applies to all companies with 50 or more workers, requires owners to track staffers’ hours, absences and how much they spend on health insurance. Many small businesses don’t have the human resources departments or computer systems that large companies have, making it harder to handle the paperwork. On average, complying with the law costs small businesses more than $15,000 a year, according to a survey released a year ago by the National Small Business Association.
“It’s a horrible hassle,” says Mete, managing partner of the Miami-based company.
One of the most anticipated cases of the Supreme Court’s 2014-2015 term is King v. Burwell. In it, the Supreme Court is confronted with what should be a straightforward question of statutory interpretation about the scope of subsidies available under the Affordable Care Act (ACA). Section 1311 of the ACA states that “each state shall, not later than January 1, 2014, establish an American Health Benefit Exchange.” Another part of the law, section 1321, then qualifies that apparently absolute duty by providing that if the state does not “elect” to establish that exchange by January 1, 2014, or if it otherwise fails to meet the federal requirements for an exchange, “the Secretary [of HHS] shall . . . establish and operate such exchange within the state.”
The question of whether a state establishes this exchange determines far more than where individuals can buy their health care coverage. It also determines whether any purchaser of health insurance is entitled to a tax credit against his or her cost of coverage, as that subsidy is limited to taxpayers who are enrolled in a qualifying plan “through an Exchange established by the state” under Section 1311. Internal Revenue Service regulations interpreted the ACA requirement so that its tax subsidies were available to all individuals whether they enrolled in an exchange established by the state or by HHS when the state elected or failed to do so. The plaintiffs’ challenge to the regulation was in essence that the plain language of the ACA precluded the IRS from expanding the scope of the subsidy by this sleight of hand. King would have been an open-and-shut victory for the plaintiffs if the disputed interpretation had been some run-of-the-mill tax provision. But 36 states did not establish these exchanges because they wanted to guarantee their citizens the statutory tax breaks.