State Medicaid agencies say Congress’ decision to suspend the Affordable Care Act’s tax on health insurers for one year is a good first step, but they are pushing for its permanent repeal.
While most private health insurance plans have had to pay the tax themselves, states that contract with Medicaid managed-care plans have had to cover the premium tax to ensure that the health plans receive actuarially sound rates. Thirty-eight states and the District of Columbia contract with Medicaid managed-care plans.
Congress’ decision to suspend the Affordable Care Act’s tax on health insurers for one year will cost the government $13.9 billion, funding that normally would go to cover subsidies for low-income enrollees and other functions of the law.
The CMS, therefore, expects insurance companies to keep their premiums in check when they file 2017 rates this spring. The hope is the one-year tax reprieve will put a ceiling on premium increases and push savings to consumers instead of into the coffers of health insurers.
“Because the fee is not being collected for the 2017 fee year, administrative costs for plans in all impacted markets are expected to be adjusted appropriately to account for the moratorium,” the CMS said in a document posted Monday.
While many Americans are obsessively following the presidential primary campaign, health policy experts are concerned about little-noticed Republican primary contests for state legislative seats that could determine the fate of Medicaid expansion in Arkansas and other states.
In Arkansas, Tuesday’s elections include several primary contests pitting Republican state lawmakers who voted for Medicaid expansion to low-income adults against GOP primary challengers who promise to end the state’s coverage expansion. Republican Gov. Asa Hutchinson needs votes from 75% of the GOP-controlled Legislature to win approval for his conservative changes in the state’s Medicaid expansion program, or else the expansion will end this year. So he can’t afford to lose any expansion allies.
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.
There’s not much more time to speculate about how the Supreme Court will handle health care-related cases without the late Justice Antonin Scalia. A number of them are fast approaching on the court’s calendar, including one scheduled for arguments Tuesday.
Legal experts say they expect the court will go ahead and hear those cases and others despite the conservative justice’s unexpected death late last week.
The case set to be argued Feb. 23 involves the penalties companies face for patent infringement and could have a significant impact on the medical device industry. And in two weeks, the court is scheduled to hear a major case over whether Texas has gone too far in regulating abortions.
The death of U.S. Supreme Court Justice Antonin Scalia, who famously said the Affordable Care Act should be called “SCOTUScare,” leaves in limbo a number of health care-related cases. The news also quickly sparked a debate over who would replace him amid the presidential campaign.
The Supreme Court justices are considering a number of important health care cases focusing on topics including abortion and the ACA’s contraception mandate.
The court is also weighing a case about data sharing with potential implications for insurers and state health care reform efforts and another case with the potential to reduce—or increase—the number of False Claims Act suits brought against health care providers and other companies.
Health insurers that sold plans on the exchanges in 2015 and enrolled droves of high-cost members, could haul away as much as $7.7 billion this year, as part of the healthcare law’s reinsurance program.
The CMS released a memo (PDF) late Friday that said the agency expects its jar of reinsurance money will total $7.7 billion. The payouts, to be issued this year, will reflect data from the 2015 benefit year.
In 2015, the U.S. federal government spent more on healthcare than on Social Security for the first time. The Affordable Care Act’s expansion of Medicaid and the growing availability of subsidies for exchange plans are driving much of the higher spending.
Enrollment in the ACA’s insurance exchanges will hover around 13 million in 2016, the Congressional Budget Office said in an expanded economic report Monday, down from its previous estimate of 21 million but still above HHS’ most optimistic projection.
Health insurers in the Affordable Care Act exchanges will see changes from the Centers for Medicare & Medicaid Services this year to strengthen the market, including eliminating special enrollment periods and an early look at plans’ risk-adjustment data, the top CMS official, Andy Slavitt, said on Monday.
Humana will lose money on its 2016 individual market health plans, and the health insurer expects up to 300,000 will drop their coverage by the end of this year, according to a Securities and Exchange Commission filing released late Friday.
It marks the second investor-owned insurer to publicly disclose the problems it is having with the Affordable Care Act’s insurance markets. UnitedHealth Group has lost millions on the marketplace and said it may exit the exchanges by 2017 if things don’t turn around.