About 1.4 million households that got financial help for health insurance under President Barack Obama’s law failed to properly account for it on their tax returns last year, putting their subsidies at risk if they want to keep coverage. The preliminary figures were released by the IRS late Friday afternoon, a time when the government often reports unfavorable developments.
The Obama administration wasn’t able to ensure that all tax-credit payments made to insurers under the health law in 2014 were on behalf of consumers who had paid their premiums, according to a federal oversight agency. The Health and Human Services’ Office of Inspector General released the report Wednesday. The findings raise questions about the oversight of tax-credit payments that went to insurers on behalf of consumers who qualified for financial assistance.
Are New Yorkers looking at a health insurance tax to pay for the more than $200 million in unpaid doctor and hospital bills remaining after the collapse of the state’s consumer-run nonprofit insurance co-op? Or could that money come from the billions in bank settlements that have flowed to state coffers in recent years?
Those are among the questions that lawmakers and Gov. Andrew Cuomo will likely be debating in the upcoming legislative session. Also unclear is the future status of the approximately 215,000 New Yorkers who had low-cost health insurance policies through the short-lived Health Republic co-op.
The Department of Health & Human Services’ Office of the Inspector General found that the Centers for Medicare & Medicaid Services (CMS):
• Did not have an effective process in place to ensure that advance premium tax credit (APTC) payments were made only for enrollees who had paid their monthly premiums; instead, CMS relied on each qualified health plan (QHP) issuer to verify that enrollees paid their monthly premiums and to attest that APTC payment information that the issuer reported on its template was accurate; and
• Had sole responsibility for ensuring that APTC payments were made only for confirmed enrollees and did not share these data for enrollees with the IRS when making payments.
The OIG determined that CMS’s processes limited its ability to ensure that APTC payments made to QHP issuers were only for enrollees who had made their premium payments.
According to the Department of Health and Human Services, half the uninsured who are eligible for subsidized coverage through the exchanges have refused to purchase it. As a result, those remaining in the insurance pool have tended to be sicker and older — and they’ve used more health services than insurers expected.
How much more? According to the consulting firm McKinsey & Co., insurers collectively swallowed $2.5 billion in unexpected medical expenses from exchange enrollees in 2014.
December’s omnibus budget package contained a measure to delay a provision of the Affordable Care Act by two years is giving finance chiefs some extra time to prepare.
The tax on high-cost employee health plans, or “Cadillac” tax, puts employers on the hook for a 40% levy on any excess cost of health plans above certain thresholds. Even before the delay, many companies and municipalities had already begun to assess whether their plans would trigger additional payments and make preemptive changes to avoid it.
A bill intended to repeal key parts of the Affordable Care Act and defund Planned Parenthood would now decrease the deficit by about $553 billion, should it become law.
The legislation would save about $318 billion without macroeconomic benefits between 2016 and 2025, according to an updated score of the bill by the Congressional Budget Office and the Joint Committee on Taxation.
Many insurance companies are losing money selling ObamaCare policies. Unfortunately, the White House wants to make their losses your problem. In December, Congress refused an administration request to provide insurers with $2.5 billion in bailout money to help cover their 2014 losses.
The Obama administration hasn’t given up. It has declared that this $2.5 billion in corporate welfare and potentially billions more for losses insurers have incurred in 2015 is “an obligation of the U.S. government for which full payment is required.”
If it’s December, it must be time for a massive, one-time, all-or-nothing annual spending bill. That’s just what has become of Congress’s core function over the past decade. This year’s version includes a 2,009 page omnibus appropriations bill and a 233 page tax bill mostly extending various “temporary” tax preferences and other provisions.
Republicans have majorities in both houses, so this bill reflects their priorities on the whole. But on health care, it’s actually most interesting for what it suggests about the Democrats—some meaningful number of whose votes are after all necessary for passage.
A group of state insurance commissioners is developing a proposal to limit the amount that health insurers might have to pay out under the Affordable Care Act’s risk adjustment program, New Mexico Insurance Superintendent John Franchini told SNL.
The plan would install a so-called circuit breaker to prevent companies from paying more than 2% of their premium revenue into the program each year. That boundary would make insurers’ financial obligations more predictable and avoid the kinds of surprise payouts that contributed to the destabilization of several health plans in 2015.