Category: Implementation

“Former HHS insurance oversight chief Jay Angoff has filed a lawsuit against the department for not making 2015 rate filings public, arguing the administration is not abiding by its own regulations on disclosing the information.
Responding to the lawsuit, an HHS official said the agency will publish the rate information prior to the beginning of open enrollment. HHS Spokesperson Ben Wakana told Inside Health Policy late Wednesday (Oct. 1): “We are readying the rate change information. The department is committed to providing consumers accurate information so they can make informed decisions, and therefore, before the beginning of Open Enrollment, the agency will publish final insurance rates for all 50 states.””

“The majority of Americans who continue to oppose Obamacare should be greatly pleased to learn that the Supreme Court is likely to get a do-over on this misguided and too-often-lawlessly-implemented law. Ours is a nation of fresh starts and second chances: it is only fitting that SCOTUS be handed an opportunity to undo the convoluted, flagrantly political and highly controversial decision it made in June 2012. As eloquently detailed by fellow Forbes blogger Michael Cannon on September 30, “The U.S. District Court for the Eastern District of Oklahoma handed the Obama administration another – and a much harsher — defeat in one of four lawsuits challenging the IRS’s attempt to implement ObamaCare’s major taxing and spending provisions where the law does not authorize them.””

“Despite promises to the contrary by members of Congress and even the president, Americans now know that Obamacare is entangling tax dollars with coverage of elective abortion.
Last week, the Government Accountability Office released a report confirming that more than 1,000 Obamacare exchange plans cover elective abortion but remain eligible for taxpayer subsidies.
But that’s not the full story on how Obamacare funds the abortion industry.”

“Legal challenges to various aspects of Obamacare (aka the Affordable Care Act) keep traveling on a rollercoaster. Today’s episode of the law’s continuing courtroom soap opera involves a ruling by a federal district court in Oklahoma, which overturned a 2012 IRS rule authorizing premium assistance tax credits in federal exchanges (since rebranded as “federally facilitated marketplaces”). The decision improves the likelihood that the Supreme Court ultimately will consider this issue on appeal; either in the spring of 2015 or during its next 2015-2016 term.
Judge Ronald White ruled in State of Oklahoma v. Burwell that the IRS rule is “arbitrary, capricious, an abuse of discretion not in accordance with law, pursuant to 5 U.S.C. section 706(2)(A), in excess of statutory jurisdiction, authority, or limitations, or short of statutory right, pursuant to 5 U.S.C. section 706(2)(C), or otherwise is an invalid implementation of the ACA, and is hereby vacated.”
In other words, it was not just a “bad idea,” but an illegal one, too.”

“In a legal setback for the Obama administration, a federal judge in Oklahoma ruled Tuesday that people in states that rely on the federal insurance exchange are not eligible for Obamacare premium subsidies to help them pay for coverage.
Judge Ronald White, a George W. Bush appointee, invalidated an Internal Revenue Service rule interpreting the Patient Protection and Affordable Care Act to allow the premium tax credits in states that have not established their own exchange. “The court holds that the IRS Rule is arbitrary, capricious, an abuse of discretion or otherwise not in accordance with law,” White wrote.
In his ruling, White rejected the argument that striking down the subsidies would cripple the entire healthcare reform law. “Congress is free to amend the ACA to provide for tax credits in both state and federal exchanges, if that is the legislative will,” he wrote.”

“The second Obamacare enrollment season could go negative — but not because of the health care law’s critics.
Obama administration allies are weighing a focus on the loathsome individual mandate and the penalties that millions of Americans could face if they don’t get covered. It would be a calculated approach to prompt sign-ups, a task that the law’s supporters expect to be more difficult, or at least more complex, than in its coverage’s inaugural year.
There are several challenges: The 2015 enrollment period is shorter, the most motivated Americans are probably already enrolled and the law is still politically unpopular. That means that even if HealthCare.gov works well — and it couldn’t be worse than last October’s meltdown — proponents are confronting a tough messaging landscape.”

“Consumers searching this fall for the best doctor covered by their new public or private insurance plan won’t get very far on a federal database designed to rate physician quality.
The Affordable Care Act requires the Centers for Medicare and Medicaid Services to provide physician quality data, but that database offers only the most basic information. It’s so limited, health care experts say, as to be useless to many consumers.
This comes as people shopping for insurance on the state or federal exchanges will find increasingly narrow networks of doctors and may be forced to find a new one. Many with employer-provided plans will face the same predicament.”

“CMS decided not to include some payments disputed by doctors and teaching hospitals in the Open Payments database published Tuesday (Sept. 30) in order to give physicians and hospitals more time to review the information, but the highly anticipated database includes de-identified data in cases where it was unclear exactly to which physician the payments should have been linked.
The Open Payments site will include 4.4 million payments valued at almost $3.5 billion, according to CMS. Payments from drug and device makers, as well as group purchasing organizations, which were disputed by physicians or hospitals and not corrected before the end of the review and dispute period (Sept. 11) were not included in the most recent batch of Open Payments data because of timing issues, CMS officials said on a call.”

“The federal exchange is set to cut thousands of individuals from its coverage rolls this week because of unresolved inconsistencies related to immigration status, with HHS saying 115,000 will lose coverage as of Tuesday (Sept. 30). Tuesday is also the deadline for about 279,000 households to submit current income information to the exchange or risk seeing changes in their tax credits and cost-sharing subsidies that could result in higher costs for enrollees.
Furthering the saga on coverage data matching issues, the National Immigration Law Center has filed an administrative complaint under the ACA’s anti-discrimination section due to HHS’ failure to communicate with consumers in languages other than English and Spanish. The center also filed a Freedom of Information Act request in order to glean more insight into why that decision was made.”

“Finding a doctor who takes Obamacare coverage could be just as frustrating for Californians in 2015 as the health-law expansion enters its second year..
The state’s largest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more, according to a Times analysis of company data. And the state’s insurance exchange, Covered California, still has no comprehensive directory to help consumers match doctors with health plans.”