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Vital Signs

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Posts tagged: Insurance Exchanges

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Insurers not making the grade in California


Lee
Some of California's top insurers including Kaiser Permanente are protesting the state's plans to drop quality ratings from insurance listings when its exchange goes public on Oct. 1.
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Private insurance realities hit Congress personally


Boehner
The New York Times ran a quietly subversive news story Wednesday about how members of Congress and their aides will receive health coverage under the Office of Personnel Management's new proposed rule interpreting a controversial Obamacare provision.

During the drafting of the Patient Protection and Affordable Care Act, Sen. Charles Grassley (R-Iowa), an opponent of the legislation, insisted that members of Congress and their staffers should have to buy their coverage from the state health insurance exchanges the same way millions of other Americans would get it—rather than getting it through the Federal Employees Health Benefit Program as they do now. It was a commendable idea that few members of Congress probably thought through.
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Report: Delay of certain ACA requirements to cost feds $12 billion more than projected


The Obama administration's recent decision to delay the 2010 healthcare reform law's employer mandate by a year is estimated to increase the law's net cost to the federal government by $12 billion over 10 years, the nonpartisan Congressional Budget Office and Joint Committee on Taxation announced Tuesday. A relatively modest cost increase was predicted when the mandate delay was announced.

House Budget Committee Chairman Paul Ryan (R-Wis.) had requested that the CBO and JCT assess the effects of the July decision to postpone for one year the law's provision that employers provide insurance to their workers or else pay a penalty. In a six-page report, the CBO noted that its May 2013 baseline projections had estimated the Patient Protection and Affordable Care Act's insurance provisions would cost the federal government about $1.36 billion between 2014 and 2023. After the Treasury department's recent announcement, the CBO recalculated those projections and now estimates the insurance coverage measures in the law will cost the federal government about $1.375 billion over that same 10-year period.
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ANA wants exchanges to have minimum number of RNs


The American Nurses Association wants the federal government to require insurers selling plans on state insurance exchanges to have at least a certain percentage of advanced practice registered nurses in their provider networks.

The ANA proposed the minimum level would be equal to 10% of the number of APRNs who independently bill Medicare Part B in a state.
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Simple subsidy mistake could cost you $25,000 fine


Obamacare critics have warned of a potential surge in improper federal subsidies due to the administration's recently announced delay in federal verification of income and lack of employer coverage to qualify for insurance subsidies on the state exchanges. A Wall Street Journal editorial called it the “liar's subsidy.” But Americans tempted to shade the truth to qualify for the generous subsidies should take a close look at other obscure provisions of the healthcare reform law.

The July 5 rule allowing those delays led supporters to highlight provisions in the Patient Protection and Affordable Care Act meant to discourage applicants from gaming the system and garnering federal subsidies to which they were not entitled. The law allows civil penalties of up to $25,000 for applicants who submit inaccurate information because of “negligence or disregard of any rules or regulations.”
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Boehner asks about mandate reprieve for individuals, families


Boehner
A week after the Obama administration announced a yearlong delay in the healthcare reform law's employer mandate, House Republicans are demanding that the White House explain why it hasn't extended the same reprieve to individuals and families.

“Healthcare costs are going through the roof. I think Sen. Baucus had it right—this is a train wreck,” House Speaker John Boehner (R-Ohio) said Tuesday during a news conference on Capitol Hill, referring to the Montana Democrat's limited remark about the implementation of health insurance exchanges.
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'Honor system' subsidy determination could add significantly to ACA's cost


Instantaneous eligibility determination for exchange subsidies or Medicaid will not happen on Oct. 1 because of the Obama administration's decision to put off for one year requiring employers to report their employee health coverage, as well as a CMS-proposed rule published Friday loosening verification of individuals' income for the purpose of federal insurance subsidies.

In 2014, eligibility evaluations for premium tax credits and Medicaid eligibility will be based on the “honor system,” and will be performed manually by the state exchanges, rather than being based on IRS data provided to the exchanges through the new federal data hub. Experts say this will increase staff costs to manually determine eligibility. And it may increase fraud as well, thus costing the federal government more in premium subsidies.
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Could ACA delay lead to more legal woes, changes?


How can the IRS and the Obama administration simply waive a key provision of the Patient Protection and Affordable Care Act passed by Congress?

Section 1513(d) of the law unequivocally states that the employer mandate “shall apply to months beginning after December 31, 2013.” Could the administration's decision to delay the penalty on employers of more than 50 full-time employees for not providing coverage to their workers be challenged in court?
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Could insurers leaving Calif. individual market be a precursor?


First Aetna, and now UnitedHealth.

United, the nation's largest health insurer based on enrollment, followed in the footsteps of Aetna's move last month and decided to exit California's individual market. That includes leaving the state's individual health insurance exchange after saying it would participate, the Los Angeles Times reported Tuesday.
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States gearing up for health insurance exchange spending spree


States are poised to go on a health insurance exchange spending spree with money in the bank from the federal government.

As Republicans in Congress continue to gripe about spending on the health reform law, a new Government Accountability Office report found that although HHS has awarded around $3.7 billion to states to help establish health insurance exchanges, just over 10% of it—$380 million—had been spent as of March. Around 80% of that $380 million was spent on contracts and consulting, most of which went toward building out information technology systems.
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