Articles on the implementation of ObamaCare.
The copay cap on drugs is one way Covered California chose to shape the health insurance marketplace this year. Experts say the California exchange uses more of its powers as an “active purchaser” than any other state. That means it can decide which insurers can join the exchange, what plans and benefits are available and at what price.
The federal government — in pending proposed rules for 2017 — has signaled it too wants to have more of a hand in crafting plans. Though there are no plans to go as far as a monthly drug copay cap, healthcare.gov would be forging ahead on a path California already paved, swapping variety for simplicity in plan design.
“Not letting [health] plans define what’s right for consumers, but defining it on behalf of consumers … is a better model for the market,” said Peter Lee, executive director of Covered California.
“We want to make sure every consumer has good choice but not infinite choice,” said Lee.
There were two notable Affordable Care Act rules this week. A final rule for “Covered Outpatient Drugs,” which has been planned since the fall of 2010, contains $330 million in new annual costs, in addition to 3.1 million hours of paperwork. The 189-page rule regulates drug pricing, confidentiality, rebate payments, and requirements for states.
The administration also finalized “face-to-face” provisions under the ACA. The rule would require health care providers to document face-to-face encounters with Medicaid recipients when delivering health services. The rule imposes $23 million in annual costs and 190,000 paperwork burden hours.
Since passage, based on total lifetime costs of the regulations, the ACA has imposed costs of $50.1 billion in state and private-sector burdens and 177.9 million annual paperwork hours (167 million from final rules).
President Obama’s Final Budget Proposal includes:
MEDICAID EXPANSION
The budget will include three years of federal funding to 19 state governments that passed up an earlier offer to expand Medicaid coverage for more than 4 million low-income people.
TWEAK TO “CADILLAC TAX”
Obama will ask for tweaks to a tax on certain health insurance plans that is unpopular with labor unions.
President Barack Obama is having a tough time winning friends for his Cadillac tax.
His plan to dial back the unpopular ObamaCare tax on high-cost health plans, to be detailed in the fiscal 2017 budget he’ll release Feb. 9, has won him no applause from employers, labor unions or health insurers. The tax still must be repealed, they say, not merely modified.
“The ‘Cadillac tax’ cannot be fixed,” James Klein, president of the American Benefits Council, a nonprofit representing employers, said in a statement. “We’re glad the administration recognizes the ‘Cadillac tax’ is seriously flawed. But its impact in high cost areas is just one of its many problems.”
he Cadillac tax was apt to be politically unpopular. It was particularly apt to be unpopular with politically active groups, such as unions. It therefore seemed somewhat unlikely to us that the Cadillac tax would ever be actually allowed to take effect. Don’t be alarmist, we were told; the administration knows that all the parts of this law hang together. It will not start disassembling the complicated structure it spent so much time and political capital putting together.
And to be sure, the administration has not capitulated in the face of considerable political pressure. Well, it has not capitulated much. The White House did agree to push the implementation date back to 2020 from 2018. That ObamaCare’s principle architects want to be safely away from 1600 Pennsylvania Avenue before the Cadillac tax is implemented gives you a pretty good idea of how politically viable it is.
The House is expected to vote in the coming week on legislation to roll back some menu labeling requirements of the Affordable Care Act.
The Common Sense Nutrition Disclosure Act, introduced by Reps. Cathy McMorris Rodgers (R-Wash.) and Loretta Sanchez (D-Calif.), would exempt most grocery stores, convenience stores, gas stations and movie theaters from having to provide calorie counts for prepared food items.
The House bill would only apply the nutrition rule to establishments that derive more than 50% of their total revenue from the sale of food.
On February 5, 2016, the Centers for Medicare and Medicaid Services issued a guidance at its REGTAP.info recognizing a new special enrollment period (SEP), while the Departments of Labor, Treasury, and HHS issued a new guidance on student health plans.
Insurers have been sharply critical of SEPs in recent weeks, claiming that individuals who enroll through SEPS are unusually high cost and that SEP enrollees unbalance the risk pool. CMS has stated that it intends to tighten up on SEPs that might be subject to abuse. The agency retains statutory and regulatory authority, however, to recognize new SEPs where appropriate.
The new SEP recognized on February 5 is available for consumers who are without marketplace coverage because of their failure to file their taxes and reconcile advance premium tax credits (APTC) for 2014.
About 12.7 million people enrolled in ObamaCare plans this year, which is almost 9 million fewer than had once been expected and 1.4 million fewer than the upper boundary of its revised enrollment forecast.
Nevertheless, Health and Human Services secretary Sylvia Burwell declared the year “a success” and claimed that enrollment “exceeded our expectations.” In reality, ObamaCare enrollment has hit a wall.
At 12.7 million, total enrollment at the federal and state-run ObamaCare exchanges has ended up in the middle of range of the administration’s sharply lowered enrollment forecast, which they said could be anywhere from 11 million to 14.1 million for 2016. The Congressional Budget Office had previously expected enrollment to hit 21 million this year.
With the results now in from the Affordable Care Act’s third open enrollment period, it’s getting increasingly difficult to sugarcoat the extremely low numbers of enrollees relative to original projections. The 12.7 million people who signed up for an exchange plan amounts to just half as many enrollees as was projected by government and private sector research organizations when the ACA passed.
The Rand Corporation predicted 27 million, the Centers for Medicare and Medicaid Servicespredicted 24.8 million, the Urban Institute predicted 23.1 million, and the Congressional Budget Office predicted 21 million.
Since the Affordable Care Act became law, Democrats have lost majority control of the House and Senate, while opposition to the law has been constant and implacable. Despite its unpopularity, Congressmen Sander Levin and Henry Waxman, former chairs of the two House committees that had primary jurisdiction over health care reform when the law was passed, see the ACA as an important step to moving the U.S. closer to attaining universal health care. They believe Sen. Bernie Sanders’s proposal to throw away the ACA to pursue a single-payer system is counterproductive and dangerous. Levin and Waxman support Hillary Clinton as the presidential candidate who will keep the ACA moving forward.