Some of the nation’s largest companies are already taking steps to avoid ObamaCare’s “Cadillac tax,” according to a business survey released Wednesday.

About 12 percent of companies said they have taken steps to avoid being hit by the much-maligned tax on high-priced health insurance plans, which goes into effect in 2020.

Employers say they have either shifted more costs to workers, dropped their pricier options or picked plans with fewer providers, according to the annual employer benefits survey by the Kaiser Family Foundation and the Health Research & Educational Trust.

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A grace period in President Barack Obama’s health care law is allowing exchange customers to dodge the penalty while also helping them get more out of their medical coverage.

Insurers told the administration Monday in an annual meeting that making changes to the grace period is one way to make it easier for them to continue to participate in Obamacare’s exchanges. As is, the grace period leads to higher costs for health insurance policies, forcing some insurers to leave the exchanges due to massive financial losses.

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A top Obama administration health official indicated Wednesday that there are discussions underway about a settlement with insurance companies over Obamacare payments. This possibility has drawn alarm from Republican lawmakers, who warn that the administration is seeking to get around limitations set by Congress. Several insurers have sued the administration for funds they are owed under an Obamacare program called risk corridors, which is meant to protect insurers from heavy losses in the early years of the health law. A shortfall in funds has limited payouts. Congress enacted a provision preventing the administration from shifting funds into the program in 2014 but warn that judicial settlements now could be a way around that prohibition, for what they term to be a “bailout” of insurers.

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The CMS says some Medicare beneficiaries are receiving tax credits to purchase insurance through the Affordable Care Act marketplace. The agency is warning them to cancel their exchange coverage immediately and pay back the credit they’ve received.

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Senate Democrats and liberal groups are unveiling a new push to add a public option on ObamaCare on Thursday.

The effort is led by senators including Chuck Schumer (D-N.Y.), on track to be the next Democratic leader, and Bernie Sanders (I-Vt.), who galvanized liberals in his presidential campaign with a push to go even further and set up a “Medicare for all” system. Sen. Jeff Merkley (D-Ore.) is spearheading the effort.

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Sen. Lamar Alexander is introducing a bill Wednesday that would extend Affordable Care Act subsidies to plans off of the exchanges for some eligible consumers.

The Tennessee Republican is proposing that states could opt to expand the Obamacare subsidies to plans sold off of the exchanges.

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What happens to Obamacare after its namesake leaves the White House? The Affordable Care Act (ACA) has faced fierce opposition from congressional Republicans and many GOP-led state governments, survived unexpected legal challenges, and overcome a disastrous rollout of healthcare.gov. Through it all, ACA supporters could count on President Barack Obama to defend the law. But come January 20, 2017, that will change. If Donald Trump becomes president and Republicans maintain congressional majorities, the GOP could seek to repeal major ACA provisions, though Trump’s health care agenda is uncertain.

 

One of the more controversial parts of the Affordable Care Act is its expansion of Medicaid. A new study from the Mercatus Center at George Mason University reviews Medicaid’s longstand­ing problems, discusses the incentives states face as a result of the elevated federal reim­bursement rate for the ACA Medicaid expansion population, and analyzes the impact of the expansion. Overall, the expansion significantly adds to Medicaid’s unsustainable spending trajectory, likely fails to produce outcomes worth the corresponding cost, and creates a large federal government bias toward nondisabled, working-age adults at the expense of traditional Medicaid enrollees.

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If Donald Trump is elected president, one thing that is fairly certain is that we’d hear loud calls from some quarters for the incoming administration and Congress to move quickly in 2017 on a “clean” repeal of Obamacare. “Clean” means that the bill would go as far as possible to repeal the health care law without being encumbered politically by new provisions to replace it. Some conservatives will advise against embracing any new reform because of the political risk, but lawmakers should ignore this advice. If GOP leaders pass up the chance to pursue a market-based approach to health reform when given the chance, they will have no one to blame but themselves as U.S. health care slides inexorably toward full governmental control in coming years.

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What are the prospects for action on the Affordable Care Act (ACA) during the next Congress and presidential administration? There is no easy answer to that question in this unusual election year, although one’s first reaction might be “not much.” As Larry Leavitt, MPP, noted in the JAMA Forum recently, the presidential platforms suggest fundamentally different, maybe even irreconcilable, approaches.

At the risk of being proven wrong, it also seems reasonable to assume that there will continue to be a political standoff in practice next year, with neither party able to push through its preferred solutions for health care.
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