Articles on the implementation of ObamaCare.

Half of Virginia’s counties now are on track to have no health insurers offering Obamacare plans in 2018 after an insurer reversed a decision to sell individual health coverage in much of the state.

The pullback by Optima Health in Virginia ends a brief, two-week period in which every county in the United States was projected to have at least one Obamacare insurer next year.

. . .

The Kaiser Family Foundation’s Larry Levitt says, “States actually have a lot flexibility in theory under current waivers, but the guardrails are very hard to meet, which limits the amount of flexibility in practice.” During the repeal-and-replace effort, Republicans wanted to remove some of those “guardrails”—allowing states to chip away more substantively at some of the law’s benefit mandates and coverage guarantees. Sen. Lamar Alexander, though, is trying to keep his proposal more tailored. He’s focusing more on changes to the process of seeking a waiver than on the substance of what can be waived.

. . .

California and several other states will exempt themselves this year from a new Trump administration rule that cuts in half the amount of time consumers have to buy individual health insurance under the Affordable Care Act.

In California, lawmakers are contemplating legislation that would circumvent the rule in future years, too.

The Trump administration’s rule gives people shopping for 2018 coverage on the federal exchange 45 days to sign up, from Nov. 1 through Dec. 15.

. . .

Major healthcare insurer Anthem will only offer Obamacare exchange plans in roughly half of Kentucky’s 120 counties due to mounting policy uncertainty from Washington and a deteriorating market.

Anthem had earlier planned to offer individual market plans in every county in Kentucky. However, the insurer said that lingering problems with the market and massive federal uncertainty has forced its hand.

. . .

Virginia became the latest state at risk of having regions that will lack Affordable Care Act exchange plans next year, after a small insurer announced it will scale back the area where it expects to offer marketplace insurance.

The Virginia area that currently has no 2018 exchange insurer includes 48 counties and parts of six more, as well as 15 cities that are independent of counties, according to a Virginia state regulator. In total, the state has 95 counties and 38 independent cities.

. . .

HHS plans to save taxpayer dollars by curtailing waste and requiring better performance in the ACA Navigator program which pays organizations to enroll people in ObamaCare coverage. The HHS analysis showed that in 2016 “One [Navigator] grantee received $200,000 and enrolled ONE person in Obamacare.” The top 10 most costly Navigators spent a total of $2.77 million to enroll 314 people in Obamacare—costing an average of $8,800 to enroll each person (on top of tax credits and other subsidies). In the upcoming enrollment period, CMS plans to spend $10 million on promotional activities—consistent with similar spending on Medicare Advantage and Medicare Part D.

. . .

The Department of Health and Human Services announced today it’s slashing the advertising and promotional budget for the Affordable Care Act for next year. It’s planning to spend $10 million to promote the law in the open enrollment period that starts in November — compared to the $100 million the Obama administration spent last year.

On a conference call with reporters, HHS officials argued that last year’s promotional spending — which was doubled from the year before — was ineffective because signups for new customers actually went down.

. . .

A group of 11 states and the District of Columbia running their own Obamacare exchanges want more federal funding to stabilize exchanges facing higher premiums and insurer defections.

The states wrote to leaders of the Senate Health, Education, Labor and Pensions Committee with their ideas on Tuesday. Those include guaranteeing insurer payments and establishing a permanent reinsurance fund to help insurers.

. . .

Although the GOP’s plan to repeal the Affordable Care Act industry taxes died with the party’s health care bill, it’s conventional wisdom that some of the taxes will still be delayed. But there’s no plan to do so yet.
Lobbying campaigns to repeal or delay the health insurance tax and the medical device tax are ramping up, yet there’s no clear vehicle for Congress to take action. Well-wired lobbyists and Hill aides say the appetite for doing anything major on health care isn’t really there.

“It is a have-to-get-done that’s really hard to get done,” said one lobbyist.

. . .

axpayers who do not have minimum essential coverage (through an employer, a government program, or individual insurance) or qualify for an exemption must pay an individual responsibility tax. The tax is calculated on a monthly basis and is the greater of either a fixed dollar amount or 2.5 percent of household income above the tax filing limit, up to the the national average premium for a bronze (60 percent actuarial value) health plan.

The IRS has announced that for the 2016 tax filing season the average bronze plan premium used for calculating the maximum penalty will be $232 for each member of a tax household up to $1,360 for five or more members.

. . .