The Government Accountability Office (GAO) found that the ObamaCare health insurance exchanges are still easily tricked by fake Social Security numbers and immigration details, even more than one year after the weakness was first pointed out. The GAO also found that many have been double-covered by private insurance and Medicaid after enrolling in an exchange plan. “Our undercover testing for the 2015 coverage year found that the health care marketplace eligibility determination and enrollment process remains vulnerable to fraud,” said Seto Bagdoyan of GAO’s Forensic and Investigative Service wrote a testimony before the House Energy and Commerce Committee’s health subcommittee.
When President Obama’s landmark health care law ushered in a slew of new insurance options in 2013, the Andersons could not wait to sign up. But in April, when Roger Anderson fell while hiking and hurt his shoulder, he discovered, to his dismay, that simply being insured was not enough. The Andersons’ mid-tier health care plan costs them $875 a month and requires them to meet a $7,000 deductible before insurance payments kick in. Their experience echoes that of hundreds of thousands of newly insured Americans facing sticker shock over out-of-pocket costs.
Permit states to form health care choice compacts and allow insurers to sell policies in any state participating in the compact. (Compacts may not take effect before January 1, 2016)
Create an essential health benefits package that provides a comprehensive set of services, covers at least 60% of the actuarial value of the covered benefits, limits annual cost-sharing to the current law HSA limits ($5,950/individual and $11,900/family in 2010), and is not more extensive than the typical employer plan.
Reduce the out-of-pocket limits for those with incomes up to 400% FPL to the following levels:
- 100-200% FPL: one-third of the HSA limits ($1,983/individual and $3,967/family);
- 200-300% FPL: one-half of the HSA limits ($2,975/individual and $5,950/family);
- 300-400% FPL: two-thirds of the HSA limits ($3,987/individual and $7,973/family).
Create a temporary reinsurance program to collect payments from health insurers in the individual and group markets to provide payments to plans in the individual market that cover high-risk individuals.
Require the Office of Personnel Management to contract with insurers to offer at least two multi-state plans in each Exchange. At least one plan must be offered by a non-profit entity and at least one plan must not provide coverage for abortions beyond those permitted by federal law.
Limit deductibles for health plans in the small group market to $2,000 for individuals and $4,000 for families unless contributions are offered that offset deductible amounts above these limits.
Require qualified health plans to meet new operating standards and reporting requirements.
Permit states the option to create a Basic Health Plan for uninsured individuals with incomes between 133-200% FPL who would otherwise be eligible to receive premium subsidies in the Exchange.