In a major win for the industry, health insurers will not be forced to have minimum quantitative standards when designing their networks of hospitals and doctors for 2017, nor will they have to offer standardized options for health plans.
The CMS released a sweeping final rule (PDF) Monday afternoon that solidifies the Affordable Care Act’s coverage policies for 2017. The agency proposed tight network adequacy provisions and standardized health plan options in late November, which fueled antipathy from the health insurance industry.
Monday’s rule relaxes those aggressive proposals, a move that likely will raise the ire of consumer groups that have pushed for stronger insurance protections for patients. It does, however, include some victories for transparency advocates. The federal government, for example, will now have to publish all changes to premium rates, not just increases that are subject to review.
Consumers who try to sign up for insurance after the Obamacare open enrollment period will soon need to submit proof that they are eligible for most special enrollment periods, federal health officials announced Wednesday.
This new confirmation process, which is expected to start in the next few months, will only affect those living in the 38 states that use the federal Healthcare.gov site.
It addresses complaints from insurance companies that the Centers for Medicare and Medicaid Services was allowing too many people to buy insurance after the open enrollment deadline passed. This, insurers said, left them with many consumers who waited until they were sick to sign up and then dropped coverage after they received treatment. And the companies claim that created a sicker-than-expected pool of customers that was contributing to the losses on Affordable Care Act exchange plans.
House Ways and Means Committee Chairman Kevin Brady (R-Texas) on Wednesday gave a nod of approval to a proposal about Obamacare’s Cadillac tax in the White House’s 2017 budget.
“While we will disagree more than we agree today, I do believe that there are some important areas of cooperation. I’m glad that the White House has finally faced reality in one area and agreed that the so-called Cadillac tax is not workable,” Brady said during a hearing on the proposed budget.
The Obama administration released its proposed budget for 2017 this week. It includes a host of health care-related proposals, including new initiatives to increase access to mental health care, expand opioid abuse treatment, fight antibiotic resistance, address the Zika virus threat, and fund a “cancer moonshot.”
The budget also contains a number of proposals relevant to Affordable Care Act provisions. It proposes providing 100% federal funding for state Medicaid expansions for three years regardless of when the state decides to expand.
It would also modify the high-cost employer health plan (“Cadillac”) tax to take account of geographic differences in health care costs; specifically, it would set the threshold when the tax begins to apply at the greater of the current statutory dollar threshold or a state’s “gold plan average premium.”
The HHS Budget in Brief includes a request for $2.1 billion to fund the federally facilitated marketplaces and oversight of the state marketplaces.
The budget anticipates the collection of $4.335 billion and expenditure of $4.560 billion in 2017 for the transitional reinsurance program.
The Obama administration is setting up a new ObamaCare sign-up period for people who failed to file 2014 tax returns.
Jan. 31 was the deadline for most people to sign up, but this new period will provide another chance until March 31, for certain people who might have missed out on coverage because of confusion about new ObamaCare requirements regarding taxes and health insurance.
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.”
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.
There is little congressional appetite to revisit ObamaCare’s Cadillac tax in an election year, but that’s not stopping the coalition opposing it from campaigning about it.
Fight the 40, the coalition that includes unions and Fortune 500 companies as members, is still pushing for a full repeal of the 40 percent excise tax on employer-sponsored health benefits above a certain threshold. The tax was originally scheduled to go into effect in 2018 but was pushed back two more years in December.
“We will continue our work to highlight how the tax creates age, gender, and geographic disparities and how it impacts vulnerable demographics,” the group said in a memo shared first with Morning Consult.
The third open-enrollment season for health plans under the Affordable Care Act moved into its final hours Sunday night with little fanfare from Obama administration officials who had been urging consumers to buy insurance.
It was unclear whether the close of the three-month enrollment window drew any stampede of last-minute shoppers on HealthCare.gov, as was the case during the first two sign-up years. In each of those, federal health officials trumpeted a late surge of people choosing health plans as evidence of Americans’ eagerness for coverage.
But on Sunday, the officials provided no figures about the final weekend’s volume of traffic on the federal insurance website.