Audits and investigations into the effects of ObamaCare from congressional committees, government auditors, advocacy groups, and others.
Obamacare exchanges are failing to provide adequate enrollment information to the IRS for the payment and verification of tax credits, according to a new report released by the Treasury Inspector General for Tax Administration (TIGTA).
In order for the IRS to properly administer Obamacare, exchanges are required to provide monthly enrollment data, known as “Exchange Periodic Data.” As part of the law, Obamacare enrollees may elect to have their estimated tax credit sent directly to their insurance provider as partial payment for monthly premiums. But because this is only an estimate based on expected income, the IRS relies on Exchange Periodic Data to ensure that individuals have received the proper tax credit, or if they were eligible at all.
A federal government analysis that said Arizona’s health insurance co-op had gotten just a fraction of its projected enrollment last year missed thousands of signups and incorrectly showed the state not-for-profit set up under the Affordable Care Act signed up only 4% of the people it expected in 2014.
“CO-OP enrollment for the first-quarter of 2015 was 869,677 compared to 478,152 for the fourth-quarter of 2014,” said Kaminski. “This increase in enrollment on future financial performance is significant, because it demonstrates that interest is growing, along with a better understanding of how these CO-Ops operate. Additionally, for the smaller plans, the increase has allowed them to build up some scale, which is crucial for their viability going forward. However, the CO-Ops are challenged with operating efficiencies that are below par, having combined ratios as a group of over 110%. ”
The Patient Protection and Affordable Care Act (ACA) has substantially reformed the health insurance industry in the United States by establishing health insurance marketplaces, also called health exchanges, to facilitate the purchase of health insurance. The ACA has increased transparency in insurance pricing and in issuer pricing behavior. Using 2014 and 2015 Unified Rate Review (URR) data, this study examines changes in health insurance premiums made by individual health insurance issuers in 34 federally facilitated and state-partnership health insurance exchanges.
A new Avalere analysis finds that more than 2 million exchange enrollees eligible for cost-sharing reductions (CSRs) are not receiving the subsidies because they have selected a non-qualifying plan. In addition to the more publicized tax credits that lower consumers’ monthly premiums, exchange enrollees with incomes between 100 and 250 percent ($11,770 – $29,425) of the federal poverty level are eligible for CSRs. Exchange consumers must enroll in a plan on the silver metal level to access CSRs.
Louisiana Health Cooperative was among the 24 not-for-profit companies nationally to accept loans from the federal government to provide insurance coverage called for in the Affordable Care Act. The Metairie-based business was formed in 2011, secured $56 million in federal loans and sold plans in 2014 and 2015.
Most federal insurance cooperatives created under the Affordable Care Act are losing money and could have difficulty repaying millions of dollars in federal loans, an internal government audit has found, prompting the Obama administration to step up supervision of the carriers.
The Associated Press has reported that the U.S. Attorney’s office has issued subpoenas to the Massachusetts Health Connector (the state’s insurance exchange). The subpoenas cover the period during which the website experienced major technical problems and mismanagement as the state transferred to an Obamacare (ACA) exchange under former Governor Deval Patrick (D-MA).
Some consumers who got health coverage or subsidies through HealthCare.gov might not have been eligible to receive them last year because of deficiencies in the federal exchange’s internal controls, according to a government report likely to further stoke Republican criticism.
Not all the internal controls were effective in determining if applicants were properly eligible for health insurance or subsidies, the Health and Human Services’ Office of Inspector General concluded in a report released Monday. It also found problems resolving inconsistencies between some applicants’ information and federal data.
The Centers for Medicare and Medicaid Services, which implements the health law, said the report examined the first open enrollment period in 2014. The agency said it was aware of the majority of the technology issues during those early days and corrected them prior to the inspector general’s report.
As pressure mounts on state-run public health insurance exchanges to be financially self-sufficient in time for 2016, consumer operated and oriented plans created under the Affordable Care Act face the same challenge. And with two recent troubling developments in the CO-OP space, there are renewed questions about the long-term viability of these nonprofit entities that seek to compete with commercial carriers that offer plans on the public exchanges.