The goal of all insurance plans is to provide the right services to the right patient population. Insurance eligibility is a big factor, and companies spend a lot of time and effort determining if their patients qualify for coverage. The question of eligibility is also critical to the operation of the Affordable Care Act’s insurance marketplaces, and a recent OIG report found problems within the New York state marketplace that potentially led to ineligible enrollees.
Lackluster enrollment numbers, technology issues, and high maintenance costs are among the challenges plaguing ObamaCare state exchanges that were reviewed by the House Energy and Commerce Oversight Subcommittee at a hearing Tuesday.
“CMS has seemed more focused on doling out taxpayer dollars rather than overseeing how those dollars are spent,” Chairman Tim Murphy (R-PA) said of the lack of oversight.
Executives from six state exchanges—Oregon, Massachusetts, Hawaii, California, Minnesota, and Connecticut—provided testimony. So far, Oregon and Hawaii’s exchanges have both proven to be unsustainable, closing down and migrating consumers to HealthCare.gov’s federal marketplace with others likely to follow.
Chairman Murphy emphasized in his opening statement the sufficient amount of taxpayer money that was poured into creating these now-failing exchanges: “The Centers for Medicaid and Medicare Services has awarded $5.51 billion dollars to the States to help them establish their exchanges. Let me repeat that. The States received $5.51 billion in federal taxpayer dollars to set up their own exchanges. Yet, the ACA had no specific definition of what a state exchange was supposed to do, or more importantly, what it was not supposed to do.”
Grant money used to fund the exchanges was cut off in 2015 when states were expected to start bringing in enough money to continue operation on their own. Of the 17 states that chose to establish their own exchanges, nearly half face financial difficulties.
The committee hopes to find out why exchanges have struggled to become self-sustaining and whether or not any grant money will be recouped from states where exchanges have been shut down. For instance, Oregon spent $305 million of taxpayer dollars to establish its failed exchange, while Hawaii spent $205 million.
As Americans for Tax Reform points out, Tuesday’s hearing is a vital first step to addressing the urgent problems within the state exchanges—before they spread to all 17.
Bad news for New Yorkers, thanks to ObamaCare: More than 100,000 policyholders just learned that their Health Republic insurance plans will be canceled on Dec. 31. The start-up insurer (spun off from the Freelancers’ Union) is hemorrhaging red ink and has to close down.
That’s unfortunate for the policyholders, who now have to scramble to find other coverage and try to keep their doctors.
Health Republic of New York, the largest Obamacare co-op in the country, was ranked as the worst health insurance company in complaints in 2014, according to the New York State Department of Financial Services.
State regulators ordered Health Republic Friday to stop writing insurance policies as it was no longer qualified to provide health insurance policies under New York state standards. Health Republic is the sixth of 23 health insurance co-ops funded by Obamacare since 2011 at a cost of $2.4 billion.
On September 25, 2015, the Nevada Division of Insurance (“Division”) filed a petition in the Eighth Judicial District Court in Clark County to place the Nevada Health CO-OP (NHC) into a conservation/rehabilitation receivership. If the Court grants the petition, the Commissioner of Insurance will become the Receiver of the insurance company.
A federal program designed to aid federally created health plans such as the Louisiana Health Cooperative Inc. instead became the final nail in the ailing nonprofit’s coffin.
Louisiana Health — taken over by state regulators on Sept. 1 — was one of 23 plans created nationally under the Affordable Care Act to ensure there would be competition among health insurers. Altogether the co-ops received more than $2.4 billion in low-interest federal loans to get started. Only two have proven to be profitable amid restrictions that experts say have hampered the co-ops’ development.
The New York State Department of Financial Services (NYDFS), the Centers for Medicare and Medicaid Services (CMS), and the New York State of Health (NYSOH) health plan marketplace today announced actions regarding the Health Republic Insurance of New York co-op. NYDFS is directing Health Republic to cease writing new health insurance policies and the co-op will commence an orderly wind down after the expiration of its existing policies.
A New York nonprofit health insurer with more than 200,000 patients is going out of business, becoming the fourth and, by far, the largest co-op created under the Affordable Care Act to collapse this year.
In October 2013, Oregon was just another state whose Obamacare exchange failed to achieve lift-off when its Democrat governor attempted to abet the President in the launch of his “signature domestic achievement.” Shortly thereafter, Governor Kitzhaber earned two additional distinctions not enjoyed by Obama’s other accomplices: He was the first to abandon his constituents to Healthcare.gov, and resigned pursuant to an ethics scandal. Before leaving office, however, Kitzhaber made what may be the most outrageous decision of his tawdry tenure—he sicced his Attorney General on the IT firm that built the exchange as well as some of its employees.
A judge has approved a plan to partially pay hundreds of medical providers who are owed money by a Seneca-based health insurer that shut down due to fraudulent letters of credit. A state Insurance Department receivership has paid a “quarter on a dollar” to about 1,700 providers stuck with claims totaling $11.1 million from the collapse of the S.C. Health Cooperative.
A circuit judge in Columbia signed the “rehabilitation plan” Friday in the receivership that was prompted by a discovery last year that the cooperative used two letters of credit totaling $8 million that turned out to be fraudulent. In December, a judge appointed state Insurance Director Ray Farmer to be receiver of S.C. Health Cooperative finances after an audit showed the insurer to be financially insolvent, with $10.6 million in liabilities and $250,000 in assets.