The Patient Protection and Affordable Care Act (PPACA) of March 23, 2010 Part I of a II Part Article
Please Also See: The Patient Protection and Affordable Care Act of March 23,
(3/26/21)- The special enrollment period for Americans to sign up for Affordable Care Act health plans will continue through Aug. 15, the Biden administration announced Tuesday: The administration already extended the enrollment period earlier this year, but felt even more additional time was needed because of the number of workers who lost their coverage because of being laid off during the pandemic, thus losing their coverage under their employer plans.
(2/4/21)- President Biden has signed an executive order that creates a 90-day enrollment period starting February 15 on the federal insurance marketplace created under the terms of ACA. At the same time, the government will begin an outreach program with paid advertising and direct-to-consumer advertising that will inform the public about the program. The previous administration had cut back sharply the effort to inform people in the 36 states that use marketplace.gov.of its availability
The 14 states that use their own marketplace are likely to follow suit. California has already announced that it would do so. The Biden order would reopen the marketplace to all Americans, without requiring them to provide paperwork proving their eligibility.
It is estimated that there are about 14 million Americans who do not have any health insurance, and the Kaiser Family Foundation estimates that about 4 million of them would qualify for a plan without premiums.
(1/1/11)- In the 36 states that have Medicaid expansion provisions, enrollment has grown by22.2 percent between February and November, according to a paper from Manatt Health.
In the marketplace run by the federal government, sign-ups have increased 6.6%, compared with last year.
(11/3/20)- Open enrollment for health-care coverage under the terms of the Affordable Care Act began Sunday, November 1 and runs through December 15 in the 36 states that rely on the federal exchange, HealthCare.gov, with some individual state marketplaces open for slightly longer timeframes.
Coverage will start on January 1, 2021. Subsidies will vary that will lower the cost of the premium and out-of-pocket expenses. The Supreme Court is scheduled to hear a challenge to the Act starting November 10.
An estimate 5.4 million people lost their health-insurance coverage between February and May when they were laid off because of the pandemic, according to Family USA.
Premiums for one of the most popular benchmark plans dropped 2% for the 2021 coverage year for the states that use the federal marketplace, according to the Centers for Medicare and Medicaid Services.
Twenty-two more insurers will offer plans on the federal exchange in 2021, for a total of 181 health-insurance companies.
(9/29/20)-Analysts from Avalere Health have predicted that about 12 million Americans will lose their employer health care coverage by the end of this year.
The latest figures indicate that there are 13.6 million unemployed workers who may lose their employer health care coverage, and many employers are abandoning health care coverage benefits to their employees as they seek to reduce their costs.
Another complicating matter is that the Affordable Care Act may be eliminated, and with it the elimination of state and federal marketplaces to buy their health care coverage.
(7/15/20)- A study by the nonpartisan consumer advocacy group Families USA indicates that 5.4 million American workers lost their health insurance between February and March because of job losses due to layoff during the pandemic. This was a greater number of health insurance coverage loss than occurred in any year.
The nonpartisan Kaiser Family Foundation has estimated that 27 million Americans have lost health-insurance coverage during the pandemic, with that study including families of workers who lost their coverage because of layoffs.
(5/1/20)- In an 8-to-1, the U. S. Supreme Court ruling, the government will have to reimburse the insurance companies for losses they incurred under the Affordable Care Act for the so-called risk corridor wherein for participating in the federal market place set up under the law, any losses they incurred from 2014 through 2016 would be reimbursed.
Under the terms of ACA, if premiums exceeded medical expenses, the insurers would be required to pay some of its profits to the government. If however losses exceeded profits the government would reimburse the insurers for the loss. It turns out that the losses came to about $12 billion.
Congress never appropriated the funding for this obligation and that is why the insurers brought the lawsuit, but a divided three judge panel of the United States Court of Appeals for the Federal Circuit ruled against the insurers.
(4/2/19)- The final figures from the Centers for Medicare and Medicaid coverage under the terms of the Affordable Care Act showed that 11.4 million people enrolled a drop of about 300,000 from the previous year.
Most of the declines came in states that relied on platforms overseen by the federal government that cut advertising and outreach budgets.
Average rates for popular plans sold on the exchanges fell about 1.5%, the first such drop since the plans were offered
(1/ 5 /19)- Sixteen states and the District of Columbia have appealed the Texas judge’s ruling that invalidated the Affordable Care Act which means the act will remain in effect during the appeal process.
The appeal will go to the Fifth U.S. Circuit Court of Appea[s in New Orleans, which will set out a schedule to consider the case on Thursday..
(12/23/18) In the latest open enrollment period for health-care coverage under the Affordable Care Act that ended on the 15th, the 39 states and District of Columbia the number of sign-ups total 8.45 million, down from 8.82 million at the same point last year, a drop of 367,000 or about 4 percent
The greatest amount of sign-ups were in Florida (1.8 million), Texas (1.1 million) North Carolina (502,500) and Georgia (460,100).
Among the states showing the largest declines were Louisiana and West Virginia.
More than three-fourths of the individuals signing up this year were renewing coverage.
(4/16/17_ The Trump administration announced new rules on 4/13 including one that would cut the annual open enrollment period in half, so it would run from Nov.1 through December 15 this year for health insurance starting Jan. 1, 2018.
If an individual wanted to sign-up at any other time, he/she would have to submit documents to prove that he/she was eligible for a “special enrollment period”.
(3/16/17)- The House Republican legislation that is aimed at replacing the Affordable Care Act would increase the number of people without health insurance by 14 million by 2026, according to a report from the Congressional Budget Office (CBO), an independent federal agency. This would leave 52 million Americans without insurance.
The House Republican legislation, known as The American Health Care Act (AHCA) would cut $337 billion from the federal deficit within that 10-year period of time, according to the CBO estimate.
Average premiums for people buying their own health insurance would be 15% to 20% higher in 2018 and 2019, according to the agency’s estimate. They would decrease in the following years, according to the CBO estimate.
These figures were immediately questioned by President Trump, and other Republican leaders, since previous estimates from the CBO missed the mark as to the Affordable Care Act.
(3/11/17)- Budget rules that were set in 2011 require that spending increases by the federal government over a 10-year period of time must be offset by spending cuts over that same period of time. The Congressional Budget Office (C.B.O.), was set up by Congress in 1974 as the independent agency that provides forecasts of legislative costs will estimate the cost of the American Health Care Act (AHCA), the official name for the Republican plan to repeal and replace the Affordable Care Act (ACA)
If the C.B.O. rules that the Republican plan increases the costs of the A.C.A, Senate filibuster rules come into effect. If the C.B.O. estimates that the rolls of the uninsured would increase under the Republican plan, it could have serious negative political consequences for the Republican part.
The C.B.O. estimates are expected to announced Monday.
(2/16/17)- Humana, the health-care insurance company announced that it would no longer offer its private insurance plans under the terms of the Affordable Care Act, starting in 2018. The Louisville, KY based company offered its plans in 11 states for 2017.
Humana’s plans covered only about 150,000 policy holders, out of the about 12 million individuals that have become covered under the act
Nationally, 12 percent of adults in the US didn’t have health insurance during the first nine months of 2016, the Centers for Disease Control and Prevention (CDC) reports.
Six states —
Florida, Georgia, Mississippi, North Carolina, Oklahoma, and Texas — had
uninsured rates higher than the national average. There were 20.4 million fewer
uninsured persons during that time last year than in 2010, when the Affordable
Care Act was passed.
(2/7/17)- About 9.2 million people signed up for their health insurance at the federal market place site HealthCare.gov. during the recently concluded 4th enrollment period, under the terms of the Affordable Care Act.(ACA). The number therefore was down about 4% from last year’s enrollment total of 9.63 million individuals.
This number does not include enrollment in the 11 states that run their own online health insurance marketplace under the terms of the act. It is estimated that these states have signed up about 3 million people.
In New York 908,200 signed up through that state’s marketplace for either a qualified health plan or the “basic health program” authorized by the ACA for low income people. That is about a 39% increase for New Yorkers
About 3 million or about one-third of those who enrolled on the federal marketplace site were first time buyers. The fourth annual enrollment period for health insurance under the act began on Nov. 1 and ended on January 31.
(1/30/17)- The Trump administration has pulled back on advertisements that encouraged people to sign up for their health insurance under the terms of the Affordable Care Act for 2017. Tomorrow is the last day for open enrollment under the act for 2017 coverage.
A spokesman for the Department of Health and Human Services (HHS) said it had cut back about $5 million in advertising expenses in the last few days. The department had spent about $60 million in promoting its “sign-up” program
HHS is continuing to send email messages urging consumers to its website, HealthCare.gov to enroll. 11.5 million have signed up since the enrollment period began on November 1 for their health insurance, or had their coverage automatically renewed. More than 8.5 million of the enrollees were in states that use HealthDare.gov as an enrollment site.
(1/25/17)- A prominent question on the minds of many Americans is whether or not the Affordable Care Act of 2010 will, or won’t be repealed? If repealed, will there be a health-care act to replace it?
Attention has also being given to the fact that Americans pay more for their drugs than anyone else in the world. What can be done to hold down the high cost of these medications?
Two of the possible answers to this question are by allowing the importation for drugs from Canadian certified-safe facilities, and by allowing Medicare to directly negotiate with the drug companies over the price of pharmaceuticals for Medicare Part D beneficiaries. At last count there were 41 million Americans enrolled in Medicare or Medicare Advantage plans.
Under the terms of the Medicare program, the government must cover all drugs in 6 “protected classes” conditions. Included in the 6 classes of illness are cancer, depression and H.I.V.
Congress passed the legislation for Part D coverage for Medicare beneficiaries in 2006, but that legislation precluded the federal government from directly negotiating with the drug makers. The price negotiating for the federal government on drug pricing is done by the prescription benefits managers (PBMs). The 3 largest of these PBMs are Express Script, CVS-Caremark, and UnitedHealth-Optum.
As for allowing the importation of drugs from certified- safe Canadian facilities, the question arises that these certified safe plants are not inspected by FDA inspectors frequently enough to ensure theirquality and safety.
(12/25/16) Mayor Bill de Blasio stated that the city hopes to enroll 50,000 New Yorkers for health insurance with the state’s insurance market place under the terms of the Affordable Care Act (ACA) by the end of next year
The public health system of the city oversees 11 hospitals, and could save as much as $40 million annually if it can accomplish that goal.
City officials have stated that about 1.6 million New Yorkers have enrolled for their health insurance under ACA since 2013. They also stated that the federal government reimburses providers like NYC Health & Hospitals for some care provided to those enrolled under the act.
(12/23/16)-Health and Human Resources Secretary Sylvia Burwell announced that about 6.4 million people enrolled for health insurance coverage beginning g January 1, 2017 on healthcare.gov through the extended December 19th open enrollment deadline.
That was an increase of about 400,000 from the same period in 2015. Almost 2.2 million people had their health care automatically extended. More than 2 million of the 6.4 million were first time customers. Last Thursday, the website saw 670,000 sign up, which was its busiest day in its history.
The 5 states with the most enrollees are:
1. Florida-1.3 million
2. Texas- 776,000
3. North Carolina-369,000
5. Pennsylvania- 291,00
Not included in the data are New York and California which have their own state run health insurance marketplace.
(12/8/16)- Senate Republican leaders announced that they would move as soon as the new Congress convenes in January to start repealing the Affordable Care Act.
Republican Sen. Mitch McConnell, (Rep.-KY), the majority leader stated: “The Obamacare resolution will be the first item up in the new year’”
Without announcing what their plan would be to replace Obamacare, “a defer and delay” program is what they have in mind, since there are presently about 20 million Americans who have obtained their health-care coverage in the insurance marketplace set up under the terms of the act.
This strategy would entail keeping certain parts of the act in place for a number of years, while gradually phasing in their health-care plan.
(11//9/16)- Because of the increase in the cost of the premiums for health-insurance obtained in the market places set up under the Affordable Care Act, an exemption from the penalty for failing to obtain coverage imposed on taxpayers is coming into the limelight.
That penalty is waived if the cheapest coverage available in the taxpayer’s area would cost more than 8.16% of a person’s household income
The subsidies are available to help defray the cost of the premiums for people whose incomes are less than 400%of the federal poverty level, which is about$47,520 for a single adult. About 15% of the 10.5 million who obtained their insurance did not qualify for a subsidy.
There were about 6.9 million people who bought their own insurance coverage outside one of the exchanges set up under the act. Most individuals have their coverage through their employers’ plans.
(10/29/16)- With the open enrollment for health-care insurance under the Affordable Care Act set to commence on November 1 through December 7, 2016 for coverage starting Jan.1, 2017, Obama administration officials announced an easing of the time frame for individuals whose plans have been discontinued by their present insurers. These individuals will have until Dec. 31, instead of the Dec. 15 deadline if they attest to the fact that their present insurance coverage has been discontinued.
These individuals may be able to wait until as late as March 1 to sign up for coverage under the special enrollment rules, although that would mean a lapse of coverage for 3 months.
Obama officials from the Department of Health and Human Services (HHS) conceded that under the silver plans, as an example, premiums may rise on average 25%.
One in five consumers on the federal health insurance web site Healthcare.gov will find only one insurer with offerings. The government hopes to enroll 11/4 million people next year up from a monthly enrollment of 10.5 million this year.
There are now 39 states that use the federal website for enrollment purposes. About 7 million people do not get subsidies to help pay for their health insurance premiums.
(10/22/16)- Open enrollment for 2017 coverage begins November 1 and will continue through January 31, 2017. The administration plans to send out 10 million pieces of direct mail, up from about 800,000 last year.
As we point out in our item dated 9/29/16 below, a large emphasis will be placed on social media sites such as Facebook, Twitter, Google, Amazon and Microsoft in an attempt to get younger, healthier adults to enroll. The tax penalty for non-enrollment could exceed $700 a person next year.
A new option will be available that will cover basic medical services without any deductible. That option would have a high premium.
(9/29/16)- President Obama officials announced that the government would be using social media in its endeavor to get young adults to enroll in a health plan for coverage in 2017. The enrollment period for next year’s coverage will begin on November 1. The upcoming enrollment will be the fourth one since the program started.
For 2016, less than 30% of the 13 million people who obtained coverage under the act were between the ages of 18 and 34. Health and insurance experts estimate that that figure should be at least 40% for the correct balance of healthy and sicker individuals in the program
The government will enlist online social media sites such as Twitter, Facebook and Twitch, an online platform, to try and get younger adults to sign up.
9/8/16)- It all depends on who is doing the estimating, but a survey done by the Centers for Disease Control and Prevention’s National Health Interview from January through March of this year concluded that there were 27.3 million people in this country who did not have health insurance.
That works out to a historic low of 8.6% of the adult population without insurance. The prior year’s survey indicated that 9.1% did not have health insurance.
The 2016 data was based on an analysis of 24,317 people, according to the CDC’s National Center for Health Statistics. About 15.9% o0f the 25-to-34-year=olds were uninsured in early 2016, whereas 8.1% were uninsured in the 45-to-64- year-old category.
(8/19/16)- There are still about 24 million adults in this country who are not covered by health insurance, according to a survey by the Commonwealth Fund, a health research organization. There are 20 million more Americans who are covered by health insurance than there were before passage of the Affordable Care Act.
Forty percent of the uninsured are Hispanic, which is up from 29% in 2013. Of the uninsured, 41% are white, 12% are black and 6% are Asian and other races. Data from the survey showed that 58% of those lacking insurance coverage are males. Almost half of the uninsured fall within the 19 to 34 age category.
More than half of the uninsured live in the 11 states that do not have expanded Medicaid.
(8/17/16)- Aetna Inc. will withdraw from 11 of the 15 states it presently offers health-plans through the Affordable Care Act
The company will reduce the number of counties where it sells exchange plans next year to 242 from 778. It presently has 1.1 million individual enrollees, with about 838,000 of them who enrolled on one of the exchanges.
(6/2/16)- UnitedHealth Group, the nation’s largest health insurer, informed its brokers that it has filed paperwork to offer health-insurance plans in only 6 states when the enrollment period starts for 2017 coverage under the Affordable Care Act.. The company had offered coverage in 34 state4s in 2016.
The company announced in a posting on its private website for its brokers that “at this time we have filed to offer On Exchange products” in Nevada, New York and Virginia for 2017. Harken Health, a subsidiary of UnitedHealth, previously had announced it would offer plans in Georgia, Illinois and Florida.
At the end of its first quarter in April, the company stated it had about 795,000 exchange enrollees
(5/31/16)- A recent ruling from the I.R.S. denied a tax exemption sought by an accountable care organization that coordinated care for people with commercial insurance. The federal tax agency said that the organization did not meet the test for tax-exempt status because it was not operated solely for charitable purposes, and it provided private benefits for some doctors in its network.
Accountable care organizations now cover more than 28 million beneficiaries, according to Leavitt partners, a health care consulting firm. They manage the health-care for Medicare beneficiaries for employers-sponsored insurance and for people who buy health-insurance coverage through market-places under the Affordable Care Act.
The ruling does not affect accountable care organizations formed solely for Medicare patients, but it could affect those serving privately insured patients.
(5/27/16)- The health-insurers have submitted their proposals to state insurance regulators, and they are asking for large premium increases for the next enrollment period which begins November 1, 2016. For coverage for the 2017 calendar year..
The insurance companies in New York, Pennsylvania and Georgia are seeking premium increases of over 20% The health insurers in Florida and Maryland are seeking increases in excess of 10%. So far, only the insurers in Vermont are seeking increases of less than 10%.
The subsidies that taxpayers receive under the terms of the Affordable Care Act vary according to the individual’s income and premium for coverage.
(5/19/16)- Obama officials announced that about 9.1% of the population in the U.S., or around 28.6 million, had no health insurance, compared to the 16% in 2010, when the Affordable Care Act was passed.
These numbers were in line with the figures announced by the Centers for Disease Control and Prevention last week.
(5/17/16)- The Kaiser Family Foundation has been tracking health-insurers withdrawals from the market place set up under the Affordable Care Act. Their latest count shows that more than 650 counties in the U.S. will have just one insurer on the exchanges in 2017.
That number would be up from 225 in 2016.
Of the counties with only one insurer, 70% have populations that are mostly rural.
(5/15/16)- Judge Rosemary M. Collyer of the Federal District Court in Washington ruled that the Department of Health and Human Resources did not have the authority to fund a program under the Affordable Care Act that helps as many as 7 million lower-income people to cover the cost of their deductibles, co-payments and other out-of-pocket expenses.
Judge Collyer ruled that Congress never provided explicit authority for that spending.
The Re4publican led House of Representatives had brought the suit in 2014. The Justice Department said it would appeal the ruling.
(5/13/16)- Aetna Inc., the large health-insurance company that is presently seeking to take over Humana, Inc., announced that it expects to continue selling Affordable Care Act (ACA) exchange plans, and that it might even expand the areas it will cover.
Just last month UnitedHealth Care Group announced that it would withdraw from all but a few of the 34 states where it is presently offering market exchange care coverage.
Aetna announced at its recent quarterly earnings report conference call that enrollment in its individual plans grew more than expected, to about 1.2 million, an increase of about 200,000 from the end of last year. Of the 1.2 million enrollees, about 900,000m signed up through the ACA marketplace.
(4/15/16)- Over the next 10 years, the Affordable Care Act will cost $1.34 trillion, according to the Congressional Budget Office, up 11% from projections a year ago, mostly because of higher-than-expected enrollment in Medicaid.
The law gave 22 million people access to coverage they otherwise would not have had, the report found, and the cost of providing that coverage from 2016 to 2019 will be $465 billion, 25% less than projected when the law was passed
(3/22/16)- The maximum out-of-pocket costs for consumers under the Affordable Care Act will increase in 2017 to $7,150 for an individual and $14,300 for a family. That represents an increase of $300 for 2017 over the maximum out-of-pocket set for 2016. Last year the cap was increased by $259.
Out-of-pocket costs include deductibles and co-payments, but do not include the premium paid for the insurance. Each insurer sets its own limit for out-of-pocket costs for its own plans, but that cap can’t exceed the amount set by the federal government.
Obama administration officials announced that they would begin to rate health insurers based on how many doctors and hospitals they include in their networks. The new rules were published in a recent edition of the Federal Register.
The federal government will attach a label indicating the breath of the network for each plan sold on HealthCare.gov. About 12.7 million consumers signed up or had their coverage automatically renewed in the third annual open enrollment season, which ended on January 31.
(3/8/16)- President Barack Obama recently announced that enrollment in health coverage under the Affordable Care Act had reached a new high, 20 million
The 20 million includes individuals who have received private health insurance on exchanges set up under the terms of the act, those who gained their coverage through expanded Medicare coverage in their states that allowed this program, and young adults who were able to stay on their parents health plans until age 26.
(3/1/16)- Congress recently approved a two-year moratorium on the medical device tax imitated by the Affordable Care Act that suspended it until January 2019.
Obama administration officials announced that people who want to buy their health insurance in the federal marketplace outside the annual enrollment period will now have to provide documents that show they are eligible to do so.
The new policy requires potential enrollees to submit documents like a birth or marriage certificate, if they want to sign up after the regular enrollment period. This is also true for people who lose coverage provided by an employer, a government program or other source.
There are now 38 states and the District of Columbia that use the federal marketplace at HealthCare.gov.
(2/25/16)- Over 2.8 million New Yorkers enrolled for their health insurance through the state’s insurance exchange as of January 31, according to figures released by the New York Department of Health.
That figure is up from the 2.1 million who had enrolled at the end of the previous sign up period ended February 28, 2015. Officials attributed the increase due to Medicaid enrollment and the new Essential Plan, designed for low-income individuals and families who do not qualify for Medicaid.
The numbers breakdown were 1.97 million enrolled in Medicaid plans, 379,559 in the Essential Plan and 215,380 in Child Health Plus plans.
(2/16/16)- More than 17 million people have enrolled in private health insurance plans, up from 11 million original signees in 2010 under the terms of the Affordable Care Act. Almost one-third of the Medicare beneficiaries have chosen private plans offered by the insurance industry
There are about 12.7 million beneficiaries who have signed up for Medicare Advantage plans. The government pays insurers, on average about $10,000 a year per person, for a total of over $170 billion to the Medicare Advantage insurers.
Former Democratic Governor Steven L. Beshar of Kentucky announced the creation of a nonprofit group, Save Kentucky Healthcare, which will oppose Republican Governor Matt Bevin’s attempted changes in the states participation in the Affordable Care Act. Mr. Bevin took over the Kentucky governorship in December 2015.
Mr. Beshar’s effort will begin with online advertising and organizing.
The Act allowed states to make Medicaid available to more people, but the law left it up to each state whether or not to participate, and 20 have declined. Kentucky, under Governor Beshar joined the expanded Medicaid program and established its own online health-insurance marketplace called Kynect.
Kynect tied its state run marketplace with its expanded Medicaid program, so it simplified matters for potential enrollees. Kentucky has had the steepest decline of any state in the number of uninsured individuals, and Medicaid enrollment nearly doubled.
Since taking office Mr. Bevin has taken steps to dismantle Kynect, saying it will be cheaper to let the federal government run the exchange. The federal exchange does not have the one step process of enrolling in the health insurance marketplace, while enrolling in expanded Medicaid in one easy step.
About 7% of Kentuckians younger than 65 were uninsured last year, which is below the national average of 11%.
(2/8/16)- About 12.7 million people signed up, or renewed their health-insurance in the latest enrollment period that ended January 31, under the terms of the Affordable Care Act.
9.6 million did so through the federal site, Healthcare.gov, while 3.9 millionenrolled through states that run their own sites. There are 38 states and the District of Columbia included in the Healthcare.gov site.
Sylvia Matthews Burwell, the secretary of the Department of Health and Human Services said that 4 million of the people signing up through the federal site were new to the federal insurance marketplace in 2016.
28% of the sign-ups were in the 18-to-34 age bracket, about the same proportion as last year. Among states using Healthcare.gov, the largest numbers coming on board were from Florida (1.7 million), Texas (1.3 million), North Carolina (613,500) and Georgia (587,850)
Among the states having their own insurance market-place site, California had 1.6 million getting their coverage, with 425,000 of them being new comers.
The first month’s premium
must be paid to activate the coverage.
(1/31/16)- Sunday, January 13, 12 P.M. Pacific time is the last day to sign up for health-care cover under the Affordable Care Act to avoid being penalized $695 per adult, or 2.5% of household income, whichever is greater.
Consumers can get help 24/7 by calling 800-318-2596 or by going to LocalHelp.Healthcare.gov to find a nearby office for person-to-person help. If you do not sign up by January 31, or do not have health-insurance by that date. The next enrollment period will be the 4th one under the terms of the act, but coverage won’t start until 2017.
For those who sign-up by the deadline, coverage will begin March 31. There are a few qualifying circumstances, such as getting married, having a baby or losing job-based coverage that will allow you to get late coverage.
If you had qualifying coverage under the act in 2015 you will be mailed a statement with your information, that you must file along with your income tax return for 2015. Those statements will be going out to policy holders in early February.
(1/26/16)- More than half of the 23 health coops that were formed as a result of the Affordable Care Act (ACA) failed, after receiving $1.17 billion in federal loans, according to Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services (CMS)
Andy Slavitt, in his testimony before the Senate Finance Committee, stated that the CMS is working with the Justice Department in an attempt to recoup some of that money.
The Obama administration will soon release guidance aimed at helping the surviving coops to attract funding or merger partners. Actuaries have estimated that the coops would need $10 billion in funding, but that they ultimately received $2.4 billion in government loans.
(1/20/16)- Democratic Governor John Bel Edwards signed an executive order making Louisiana the 31st state plus the District of Columbia to have expanded Medicaid under the terms of the Affordable Care Act (ACA). Mr. Edwards promised that he would expand the state’s Medicaid program when he recently ran for the office.
Under the terms of the ACA, federal funds will cover 100% of the cost, through 2016, for a state to include everyone with incomes below 138% of the poverty level. That comes to $16,242 for a single person and $33,465 for a family of four. The federal government will cover 90% of the cost to a state for expanded Medicaid for 3 more years thereafter.
298,000 Louisans will be eligible for Medicaid under the expansion, according to an analysis last year by the state’s Legislative Fiscal Office. An additional 224,000 adults with private insurance would also be eligible.
(1/15/16)- Republican Governor Matt Bevin of Kentucky notified officials of the federal government that he plans to “wind down and cease operations” of the state’s health insurance exchange. The newly elected governor sent a letter to Sylvia Matthews Burwell, the secretary of health and human services, stating that he wanted the state’s residents to start using the federal insurance exchange services “as soon as practicable”.
Kentucky residents will continue using the state’s exchange, known as Kynect, during the present open enrollment period that ends January 31. The state’s prior Democratic Governor, Steven L. Beshear, has said it would cost the state at least $23 million to dismantle Kynect.
There were about 81,000 residents of Kentucky who bought their health insurance through the state exchange, and they will remain covered by that insurance until the next enrollment period which will begin in November, 2016.
The federal government pays 100% of the cost for those individuals who obtain their health insurance under their state’s expanded Medicaid program, and 90% of the cost through 2019.
Kynect is also the portal through which residents apply for Medicaid, and if that site will no longer be available, it will be more difficult for them to apply through the federal exchange, which will direct them to their state’s Medicaid site.
(1/12/16)- Obama administration officials announced that 11.3 million people had signed up for health insurance so far during the Affordable Care Act’s 3rd open enrollment period which ends on January 31st.
About 8.6 million people have signed up or have been automatically re-enrolled in the 38 states that use the government’s website for health insurance (HealthCare.gov). In states running their own exchanges, 2.7 million have signed up.
New consumers accounted for 29% of people selecting health plans in the federal marketplace, but only 19% in the state insurance exchanges. The final tally will, in all likelihood, see young people fall below the 35% level that Kevin J. Counihan, the chief executive of the federal health exchange, had hoped to achieve.as a “good optimal number” when he ran the Connecticut health market place exchange.
(1/5/16)- The penalty for failure to have health insurance in 2016 will be $695 per adult or 2.5% of household income, up from $325 per adult or 2% of household income in 2015.
In 2014, about 7.5 million Americans paid a penalty for not having health-insurance, at an average of $200, according to preliminary data from the Internal Revenue Service. An additional 12 million received an exemption.
People are exempt from the penalty if the least expensive plan available to them through the online exchanges cost more than about 8% of their household income. For most people the penalty comes out of their tax refund.
(12/23/15)- Obama administration officials announced that as of December 17, 2.4 million of the 6 million who signed up for their health insurance were new customers. They stated that is about one-third more than had signed up last year ahead of the deadline for coverage starting January 1.
Enrollments for insurance coverage under the Affordable Care Act have until January 31, 2016 to sign up. The federal exchange, HealthCare.gov serves 38 states and the District of Columbia..
The 6 million figure that was announced does not include consumers with coverage this year that will be automatically re-enrolled, or people who sign up on the state exchanges.
(12/15/15)- Obama administration officials announced that they had recouped over $200 million in funding that had been given to states that had failed to properly set up their systems for the health-insurance marketplace under the terms of the Affordable Care Act.
The federal government had granted more than $4 billion to 17 states to help them establish their own health insurance exchanges. Hawaii, Nevada and Oregon all chose to give up on their operations and rely on the federal government’s HealthCare. gov exchange. The federal government’s site is now used by 38 states and the District of Columbia
The Centers for Medicare and Medicaid Services has denied states’ requests for more federal funds 69 times this year, and no new money will be given to fix problems
Every state based exchange has the external funds necessary to run their own exchanges. 30 states have agreed to use federal funds to extend Expanded Medicaid coverage, which has added about 11 million people to the program.
(12/11/15)- Federal officials stated that if uninsured people don’t obtain health-insurance coverage by January 31, 2016 which is the expiration date for this 3rd enrollment period, they won’t get an extension to avoid the Affordable Care Act’s penalty for going without insurance.
The government did allow an extension during last year’s 2nd enrollment period, when the deadline was February 15..People were given an extension through April to sign up if they said they had missed the deadline because they only learned about it when they filed their tax return due April 15.
An analysis by the Kaiser family Foundation estimated that the average tax penalty would be $960 per household for those who do not enroll for health-care coverage in 2016.The penalty is rising to $325 per adult or 2% of household income, and for 2016 it will increase to $695 per adult or 2.5% of household income.
According to preliminary data from the Internal Revenue service Americans paid an average penalty of $200 in 2014 for goimg without insurance. An additional 12 million received an exemption. The penalty generally comes out of people’s refunds.
(12/1/15)- Open enrollment for health-care insurance 2017 sign up under the Affordable Care Act will start on November 1, 2016, and end on January 31, 2017, according to administration officials. These dates are in fact the same ones being used for the 2016 open enrollment period.
The presidential, state and local elections will take place on November 8, 2016, so the Affordable Care Act will be one of the premier issues in the 2016 election campaigns.
(11/26/15)- There are several new features that have been incorporated in the federal health insurance marketplace within HealthCare.gov. One of the new search engines is one that will allow consumers to type in the names of their doctors, prescription drugs, and preferred hospitals, and see which plans cover them.
There will be a cost-comparison tool for users to estimate their probable out-of-pocket and total costs, including premiums, deductibles and other charges, under different health plans. In making the calculations, the site will use a person’s age, sex, income and ZIP code.. The site will show premiums reduced by the amount of any subsidies that a family may receive in the form of tax credits
(11/22/15)- UnitedHeath, citing its inability to make a profit from its participation in the state-health-insurance market place created under the terms of the Affordable Care Act, said that it is contemplating withdrawing from that market in 2017.
The company has plans that offer health-insurance in 34 states next year, and has enrolled about 550,000 customers to date. Administration officials expect to enroll about 10 million policyholders in 2016, and UnitedHealth is not considered to be one of the major individual insurers for people getting their coverage from these exchanges.
(11/13/15)- In our item dated 10/30/15 below, we noted that 9 of the health-care-co-op insurers formed under the terms of the Affordable Care Act. That number is now up to 12, with the latest casualty being the Consumers Mutual Insurance of Michigan posting a notice on its website saying that it will not sell health plans in 2016 on the insurance marketplace.
Health Republic Insurance of New York, the largest of the co-ops had previously announced that it “will not be available after November 30.” That closure affected 155,000 New Yorkers.
(11/4/15)- The price of the second lowest-cost mid-range “silver plan” will rise by 7.5% on average in the states that rely on Washington to administer their health insurance market place. Enrollment for coverage in 2016 began on Sunday, November 1 and ends on January 31, 2016.
A new feature on the HealthCare.gov website will allow consumers to get an estimate of their total costs under different health plans, depending on whether they expect to use a low, medium or high volume of medical services in 2016.
Consumers will be able to tell which doctors are in a plan. The results for searches on the federal site will list the premiums, from the cheapest to the most expensive. Plans are also required to list their deductibles before coverage begins to pay for medical services.
In order to be entitled to receive a subsidy toward the cost of their health insurance coverage under the Affordable Care Act a tax return had to be filed in 2014. The IRS released figures showing that 710,000 individuals who received subsidies had not filed tax returns and had not requested more time to do so. Letters have been sent to these individuals that advise them that they are at risk of losing their subsidy.
The IRS also said 760,000 taxpayers had received subsidies but had not attached the required form comparing the subsidy paid with the amount they were entitled to receive. Many have complained that that form, IRS Form 8962, is too complicated to fill out.
(10/30/15)- Of the 23 health care co-op insurers formed as a result of the Affordable Care Act, nine have closed. The three largest are among the casualties. These co-ops were formed with the aim of fostering competition in the industry, which in turn would lower premium costs for health-insurance coverage is not happening to the detriment of the public.
Please keep in mind that because of pending mergers in the health insurance industry, this will also work to the disadvantage of health insurance purchasers. Because of the failure of the nine co-ops, about 500,000 of their customers will be scrambling to find new coverage.
The failures include co-ops in New York, Colorado, Kentucky and South Carolina. It will cost the federal government over $1 billion in loan guarantees to the co-ops that have failed.
(10/26/15)- About 7.5 million taxpayers paid the $95 fine for not having health care insurance in 2015, according to a preliminary report from the Internal Revenue Service. That is significantly more than the three to six million that the government had forecasted.
The federal government is paying subsidies in the form of tax credits to 8.7 million people, including 2.3 million in states that run their own marketplace.
The penalty goes up to $695 per person (($347.50 per child under 18) in 2016, with the maximum penalty being $2,085 per family. There is also a maximum penalty of 2.5% of your yearly household income. Only the amount of income above the tax filing threshold, about $10,150 for an individual in 2014, is used to calculate the penalty
The average tax credit for the
subsidy is $272 a month.
(10/22/15)- The third sign-up period will begin on November 1 for those hoping to get their health-care insurance in either the federal (healthcare.gov) or state insurance market place set up under the terms of the Affordable Care Act (ACA).
Health and Human Services Secretary Sylvia Matthews Burwell said she had set a target of 10 million people to have paid-up health insurance by the end of 2016
That is only a slight increase from the 9.9 million who had enrolled and paid their premiums as of June. It is estimated that there are about 10.5 million Americans who do not have health insurance.
Medicare Part D: A First Look
at Plan Offerings in 2016 finds that for the coming year, the average
beneficiary will have a choice of 26 stand-alone Part D drug plans, down from
30 last year.
If currently enrolled beneficiaries stay in the same plan next year, average premiums are projected to rise to $41.46 per month, up from $36.68 this year. Many enrollees have access to plans that could lower their premiums or reduce their total drug costs. But, in a typical year, about 9 in ten Part D enrollees stick with the same plan rather than make a switch. (Kaiser Family Foundation)
(10/4/15)- A bill passed by a voice vote in both the House and Senate, eliminates a provision in the Affordable Care Act (ACA) that would have imposed a mandatory definition of a “small employer” as one with 51 to 100 employees. A spokesman for President Obama confirmed that he would sign the bill.
For more info on this matter, please see our item dated 9/22/15 below. That provision in the ACA would have requirted employers with more than 50 employees to providing health insurance, whereas many states define a “small employer as one with 50 or less employees.
The bill would allow states to expand their definition of a “small employer” as those with 51 to 100 employees if they chose to do so.”
(9/30/15)- The enrollment period for obtaining health-insurance under the terms of the Affordable Care Act will run from November 1, 2015 through January 31, 2016.
The Congressional Budget Office (CBO) estimates that up to 21 million people will use the online portals to obtain health insurance coverage for 2016. The tax penalty for those who are uninsured will increase to $695 a year for an individual in 2016.
About 9.9 million people now have coverage through the federal and state insurance marketplaces. Federal officials stated that they would give particular attention to the Dallas, Houston, northern New Jersey, Chicago and Miami areas in their attempt to get people to enroll for health insurance.
Subsidies are available only for people who buy their insurance through the federal or state market place sites. It is estimated that there are still 10.5 million people without health insurance.
(9/22/15)- One of the provisions of the Affordable Care Act expands the definition of a “small employer” to include companies with 51 to 100 employees, effective January 1, 2016. As a general rule, states define a small employer as those with 50 or fewer employees.
When this change becomes effective many companies will have to offer a package of “essential health benefits”, as specified under the law.
Insurers will no longer be able to set premiums for such groups based on their claims history, industry or size. Premiums will have to be agreed to by state regulators. Many insurance experts are worried that this will cause a significant increase to both the employees and employers.
(9/18/15)- In its annual report on income, poverty and health insurance coverage, the Census Bureau said that the percentage of poor people without health insurance was 10.4% last year, down from 13.3% in 2013, down from 13.3% in 2013
Massachusetts .had the lowest percentage level of uninsured in the 50 states at the 3.3% level, while Texas had the highest level at 19%.
Almost 9 million people gained health insurance coverage last year, but there was no significant change in income for the typical American household. About 46.7 million Americans were at or below the poverty level, the fourth consecutive year in which there was no change in the number of people at or below this level.
The median household income in the United States was $53,660 last year, and the poverty rate was 14.8%
(9/10/15)- The Affordable Care Act’s tax on “Cadillac” tax on high-cost employer health insurance is due to kick in starting in 2018, when it will impose a 40%levy on benefits $10,200 or more in health benefits for individuals and $27,500 for families. Many companies are drawing up their strategies now to minimize their tax liability in 2018
Workers and employers who contribute the maximum of $2,550 a year to their Flexible Spending Accounts (FSAs) could therefore find those individuals falling under the purview of that tax.
(8/21/15)- New York state health-insurance exchange officials announced that it had helped over 2.1 million residents of the state to get their insurance during the recently completed second enrollment under the terms of the Affordable Care Act.
That number was more than double the number of enrollees during the initial enrollment period.
(8/20/15)- As of March 31, 2015 there were 29 million people without health insurance in this country. This figure represented a drop of 7 million from the average in 2014, and 8.8 million from 2013 to 2014. For the last 2 years there has been a drop of 15.8 million from the uninsured rolls. These figures were contained in a report from the National Center for Health Statistics.
The report went on to conclude that the proportion of the population without health insurance dropped by 5.2 percentage points, to 9.2 %, in the first quarter of this year, from 14.4% in 2013.
(8/16/15)- About 950,000 new customers selected their health-care coverage on HealthCare.gov after the open enrollment period when they became eligible due to changes such as losing their employer provided insurance, or having a baby, according to a report from the Centers for Medicare and Medicaid Services.
The number reflects those people who selected plans between Feb. 23, 2015 and June 30, 2015 in the 37 states and District of Columbia that rely on the federal health insurance site.
About 8.8 million people had selected a plan or were re-enrolled through HealthCare.gov during the open enrollment period this year. As of March 31, 7.5 million had coverage and paid premiums.
(7/30/15)- Peter V. Lee, the executive director of California’s insurance exchange, which is known as Covered California, announced that the state’s health-insurance rates would rise by 4% next year. California not only runs its own exchange but it also actively negotiates prices.
More than 1.3 million people have coverage through Covered California. That state accounts for 13% of the 10.2 million people enrolled in private health plans under the Affordable Care Act.
California will have 12 health- insurance companies competing for business in that state next year. It is an “active purchaser”, meaning it chooses plans that can compete in the state, and then negotiates premiums with them.
(7/23/15)- Noridan Healthcare Solutions, the main contractor for Maryland’s initial flawed state run health-care insurance exchange website created under the Affordable Care Ac,t has agreed to repay $45 million to avoid legal action because the site crashed immediately after opening on Oct. 1, 2013.
Maryland has, since the initial failure, created its own state-run health-care exchange. Oregon, Nevada and Hawaii abandoned their own state-run exchanges, and now use the federal site.
Noridan will pay $20 million upfront, and the rest will come in yearly installments of $5 million for five years. The payments represent 61% of the total paid to the company for the failed website. The agreement is subject to regulatory approval.
(7/5/15)- Under the terms of the Affordable Care Act payments are to be made under 3 different programs that are supposed to smooth out the risk for insurers that enroll a lot of less-healthy enrollees. These payments are largely funded by the other insurers that have less costly members.
Obama administration officials released the calculations of payments for 2014 for two of those programs last week. Up to now, the insurers had penciled in their estimates of potential receivables and payables to complete their 2014 reporting. Calculations for the 3rd program have not been released yet.
With the media mentioning more consolidation in that industry, in addition to the proposed acquisition of Humana by Cigna, valuations of the insurers are now in a state of flux.
(7/1/15)- Employers hoping to hold down their cost structure are looking ahead with trepidations to 2018, when a heavy excise tax kicks in on generous corporate health-care plans.
The tax, which is intended to help fund insurance for the previously uninsured under the Affordable Care Act, is 40% a year on the amount by which employer-sponsored plans exceed $10,300 for individual coverage, and $27,500 for family coverage.
(6/28/15)- The U. S. Supreme Court voted 6 to 3 in favor of the legality for the subsidies given to those who enrolled for their health-care coverage on the HealthCare.gov site, rather than on a state run site. There are still several lawsuits pending that question the legality of the Affordable Care Act, but this was the big win for the act.
(6/10/15)- The Department of Health and Human Services (HHS) published information on the proposed premiums requested by health insurers for plans under the Affordable Care Act for 2016. Under the terms of the act, insurers must justify increases of 10% or more to Obama administration officials, and must publish online explanations for these increases.
The administration can’t force insurers to reduce the proposed rates, but many state regulators can negotiate with the insurers over the proposed increases. The Blue Cross and Blue Shield of Illinois for example, is looking to increase rates by an average of 29% or more.
Nationwide, some of the big insurers are seeking double-digit rate increases.
(6/5/15)- Sylvia Matthews Burwell, the secretary of health and human services announced that about 13% of the people who signed up for health-care insurance in 2015 under the Affordable Care Act had left the insurance coverage, mainly because they failed to pay the premiums or because they had become covered by their employer.
As of March 31, 2015, 10.2 million had been enrolled. This was down from the 11.7 million announced earlier in the year. Of this total, 6.4 million were receiving federal subsidies in states where the federal government was operating the exchange-marketplace. These enrollees are the ones who would be affected if the Supreme Court rules the subsidies to be illegal under the terms of the act. The court’s ruling in the matter is expected within the next few weeks.
The federal government is paying subsidies in the form of tax credits to 8.7 million people, including 2.3 million in states that run their own marketplace.
The average tax credit for the subsidy is $272 a month.
Of the 10.2 million, 68% had selected midlevel “silver” plans, and 21% opted for “bronze” plans.
(5/29/15)- The human-resource department and health-benefit consultants are now attempting to deal with the provisions of the Affordable Health Care Act that imposes a levy, starting in 2018, for the “Cadillac tax”. That levy is 40% a year on the amount by which employer-sponsored plans exceed government-set thresholds.
This cost begins at $10,200 for individual health-care coverage and $27,500 for family coverage. The cost totals the amount employer and the employee pay for health-care premiums. Will this levy cause corporate America to shift to lower cost, less benefit plans for their employees?
(5/21/15)- In a 2-1 ruling, a panel of the Seventh U.S. Circuit Court of Appeals in Chicago ruled that the University of Notre Dame had not produced enough evidence to warrant a preliminary injunction that would allow it to opt out of the requirements of the contraception provision of the Affordable Care Act.
The University objected to the provision on religious grounds. The provision mandates that most employers include contraception in health plans with no out-of-pocket costs. The Obama administration has offered a compromise under which an employer with a religious objection can state its conflict and then have its insurance plan administrator provide contraceptive coverage.
The U.S. Supreme Court ruled last year that closely held for-profit institutions, such as Hobby Lobby Stores Inc. couldn’t be forced to cover contraception in employees’ health plans if doing so conflicted with the company owners’ religious beliefs.
(5/13/15)- In a report by the New York City comptroller, Scott Stringer, the number of uninsured hospital patients in the city’s11-municipal hospital system dropped by 1.3%, with another 7.2% decrease expected by 2019.
The report estimated that the hospital-system faced a deficit of more than $1 billion in fiscal year 2017, which will grow even greater in subsequent years. The federal government will begin cutting subsidies to those hospitals because of the fact that the Affordable Care Act will continue to cut down on the number of uninsured health-care patients.
New York City’s hospital service a large amount of uninsured residents, so the city will in effect be hurt by the law.
(3/30/15)- The so-called “Cadillac” tax on companies with high cost health plans is scheduled to take effect in 2018. The law imposes a 40% excise tax on the annual cost of health care above $10,200 for individual employee coverage and $27,500 for family employee coverage.
As 2018 approaches, this will be a major issue in negotiations between unions and employees seeking to cut their cost structure.
An analysis of the subsidies earned by participants in the health-care program under the Affordable Care Act by the Kaiser Family Foundation concluded that over half of them will have to repay a portion of it to the federal government.
The foundation also predicted that 45% of households that received subsidies will probably get a refund, because their 2014 income was lower than what they estimated when they applied for coverage
People earned subsidies if they earned between 100 and 400 percent of the federal poverty level. Taxpayers received the subsidies in advance, with the amount determined by their projected household income for 2014.
The foundation estimated that subsidy recipients who underestimated their income will owe $794 on average, while those who overestimated income will receive average refunds of $773.
(3/25/15)- The latest Kaiser Tracking Poll, conducted in early March by the Kaiser Family Foundation, a nonpartisan health policy research group, found that 43% of respondents had an unfavorable opinion of the health law, while 41% viewed it favorably. Last July, 53% of the respondents viewed it unfavorably, while 39% viewed it favorably.
The nationwide tracking poll of 1,503 adults was conducted March 6 to 12, using cellphones and landlines. Interviews were in Spanish and English. The margin of sampling error was plus or minus 3 percentage points for the full sample.
(3/22/15)- March 23rd will be 5th year anniversary of The Patient Protection and Affordable Care Act (PPACA). The U.S. Supreme Court is expected to rule on the legality of the subsidies afforded to those who signed up for their health insurance on the federal HealthCare.gov site by May or June of this year.
Sylvia M. Burwell, the secretary of health and human resources disclosed that the recent data showed “the largest reduction in the uninsured in four decades” That would take us back to when Lyndon Johnson was president in 1965 when Medicare and Medicaid were created.
16.4 million Americans have gained health-insurance in the last five years. Since the first open enrollment began in October 2013, the proportion of adults lacking insurance has dropped to13.2%, from 20.3 percent. Richard G. Frank, an assistant secretary at the health and human services department stated that 14.1 million uninsured people in the 18 to 64 age category have gained health-insurance, with 2.3 million being covered in the period from2010 to October, 2013.
In addition, 2.3 million young adults were covered in that time frame because they were allowed to stay under their parent’s coverage until the age of 26.
The Congressional Budget office had previously announced that the number of uninsured people under the age of 65 had decreased by 17 million, to a total of 35 million.
(3/17/15)- The Congressional Budget Office (CBO) lowered its estimate of the cost of the Affordable Care Act by 20% from its prior estimate in January. It also lowered the cost estimate for Medicaid by 8%. It now projects deficits totaling $7.2 trillion from 2016 to 2025, a decrease of 6% from its January estimate.
“The largest factor underlying that reduction is a downward revision in projected growth in premiums for private health insurance”, according to the agency. Five years ago the budget office predicted that people receiving subsidies would get $5200 in 2015, whereas the latest estimate is that it would average $3,960 per individual in 2015.
It also estimated that the number of
uninsured would be in the 24 million range in 2017-2019, down from its prior
estimate of 26 million.
(3/13/15)- The Obama administration said that 11.7 million Americans now have private health insurance through the federal and state insurance-exchanges, with 86% of them receiving subsidies from the federal government to help pay for their premiums.
About 8.8 million of the consumers live in the 37 states covered by the federal HealthCare.gov website. Florida is the state that has the most people who got their coverage through the federal website, having had about 1.6 million consumers being covered. About 1.5 million of them qualified for a subsidy.
Texas is next with about 1.2 million gaining coverage, with one million of them qualifying for subsidies.
For those who enrolled on the federal exchange, they paid an average of $101 per month after the subsidy tax credit. For people in states using the federal website, tax credits averaged $263 a month, which reduced their premiums by 72%, on average.
Of the 4.2 million people who had coverage in the federal marketplace in 2014 and 2015, about 1.2 million, or 29%, switched to a different plan.
(3/5/15)- The U.S. Supreme Court heard oral arguments yesterday over the legality off the subsidies given to individuals who bought their health-care insurance on the HealthCare.gov site that was operated by the federal government. There were 37 states wherein the federal government operated the site, and it is estimated that about 7.5 million individuals will be affected by the court’s ruling in this matter.
The decision from the court is expected sometime in June.
About 1.2 million people who bought health-care coverage on HealthCare.gov in 2014 dropped their plan, and picked a new one through the site for 2015, according to Obama administration officials. Nearly 2 million were automatically renewed with their 2014 plan when they took no action in 2015. About one million went back onto the site, but did not change their plan, according to new figures from the Centers for Medicare and Medicaid Services. (CMS)
About 4.2 million of this year’s sign-ups were people who had coverage through HealthCare.gov in 2014. 8.8 million people have picked plans through the federal health-insurance exchange. There are 13 states that operate their own exchanges. Between the federal and state exchanges, there are now a total of 11.4 million who have signed up for their health insurance in 2015.
Republican Governor Gary Herbert of Utah criticized the state’s Republican controlled House for deciding not to consider his plan for expanded Medicaid as called for under the Affordable Care Act. Speaker Greg Hughes of the House said that it would not consider the governor’s plan because it had no support.
The governor had negotiated his plan with federal officials, and had been approved in the State Senate. Thus, there continues to be 28 states that have adopted some form of the expanded Medicaid program.
(2/20/15)- The state of Washington announced that it would extend its sign-up deadline for health insurance on its state run exchange until April 17th. Thus, tax filers will see that they were penalized with a fee for not having health insurance in 2014.
Several other states that run their own health-insurance exchanges said that would allow consumers who started but did not finish the enrollment process by the 15th, to have additional time to enroll. These states include: California, Colorado, Connecticut, Maryland, and Massachusetts, Minnesota, New York Rhode Island and Washington, D.C.
(2/19/15)- The federal government announced that it would give people who started but were unable to finish their enrollment process in the federal health insurance exchange at HealthCare.gov through February 22nd to finish applying for coverage and picking their plans, and most states have also agreed to similar extensions on their state health-insurance sites.
About 11.4 million Americans picked health plans through the federal or state run exchanges. HealthCare.gov serves 37 states, and 13 states run their own health-exchanges.
(2/18/15)- Every adult without health-insurance after 2/15/15, with certain exemptions will be subject to a minimum penalty of $325, or 2% of income (whichever is higher) when filing their 2015 income tax returns, up from the $95 or 1% of their income (whichever is higher)minimum penalty for income tax returns filed for 2014. This penalty will rise to $695 per adult when filing your 2016 income tax return.
There are more than 30 exemptions from incurring the penalty for not having health-insurance. One is for low-income people who live in states that do not have an expanded Medicaid program. Another is for people who would have to pay premiums that would be more than 8% of their total household income. The government will also allow a variety of hardship exemptions.
The administration is cutting off health-insurance coverage for about 200,000 people who failed to prove they are legally living in this country. Health insurance would terminate February 28 for people who have signed up for coverage in 2014, under the Affordable care Act, and whose insurance had been automatically renewed for 2015, after officials concluded the people had not supplied enough information to verify their immigration status.
This move comes after the administration previously told insurers to drop about 112,000 individuals who did not respond to letters seeking more information on their legal status.
(2/12/15)- At last count there were 28 states that had joined, in some form or other, the expanded Medicaid program, under the Affordable care Act. Republican Governor Bill Haslam of Tennessee’s plan to join the program, that we wrote about in our item dated 12/18/14, was defeated by the Republican controlled legislature in that state. Wyoming’s plan to join the program was also defeated by the state’s legislative body.
Newly elected Democratic Governor Tom Wolf of Pennsylvania is scrapping his Republican predecessor’s plan for an expanded Medicaid program in favor of joining in with the “straight federal expanded Medicaid” program.
Republican Governor Gary R. Herbert has negotiated a tentative deal with Obama administration officials for an alternative expanded Medicaid program, but the Republican controlled legislature in that state will not go along with the deal. A vote is expected within the next few weeks on the deal.
(2/9/15)- Republican Governor Bill Haslam’s proposal to extend health-care coverage to 280,000 low-income residents of Tennessee was defeated by a 7 to 4 vote in the Senate Health Committee. Mr. Haslam had spent 21 months negotiating with federal officials for a special deal for the state that included vouchers to buy private insurance, and assurances that the state could pull out if the deal cost more than expected.
Hospitals had pledged to cover the $74 million state share of the deal. Under the deal, the state would have drawn $2.8 billion in federal funds under the Affordable Care Act.
On the other hand, Arkansas, the first state that authorized using federal funds to buy private health insurance for its poorer residents, reauthorized the deal for another year. The plan was devised 2 years ago as an alternative to expanded Medicaid under the Affordable Care Act. Governor Asa Hutchinson, a Republican is expected to sign the reauthorization.
(2/2/15)- Republican Governor Mike Pence of Indiana announced that the state would join the expanded Medicaid program, after the state had obtained certain concessions from Obama officials. Under Indiana’s agreement, the state can require some Medicaid enrollees to contribute toward their medical care.
It is estimated that about 350,000 residents of the state would qualify for the coverage beginning February 1. The Medicaid program covers about 50 million people in this country. The expanded Medicaid program is aimed at covering residents of a state who earn up to a third more than the federal poverty level, or around $15,500 for a single adult.
Indiana’s agreement is the first time a state has been allowed to impose strict requirements on some Medicaid enrollees to pay a portion of their premiums, up to $26 a month for a single adult, or get locked out of the program.
Under the Indiana waiver, new beneficiaries in the program with incomes under the poverty level of around $11,700, for a single adult, would be required to pay 2% of their month’s income, or lose benefits. All enrollees would be required to pay at least $1, and the fees could go up to $20, for a single adult, or more for a family.
Individuals making a little above the federal poverty level would also be required to make a 2% contribution which could range from about $20 to $26 a month for a single adult, and they could be locked out of coverage for 6 months if they fall behind in their payments. Many of the enrollees would have copays of up to $25 for repeat inappropriate visits to emergency rooms..
(1/29/15)- Health and Human Services (HHS) Secretary Sylvia M. Burwell said it's still too early to take a bow, but she's "encouraged by the strong interest we've seen so far." She made that statement because through the middle of January, more than 7.1 million people had signed up in 37 states where the federal government is running the health-insurance markets. At least another 2.4 million signed up in states running their own exchanges.
The health insurance exchanges offer subsidized private coverage to people who don't have access on the job. The deadline for 2015 enrollment is Feb. 15, and officials are expecting the numbers to surge at the very end. The legality of this subsidization is being questioned in a case presently before the U.S. Supreme Court, with the decision expected sometime in May.
The top five states were Florida, with nearly 1.3 million signed up were California, with 1.2 million; Texas, with nearly 920,000; North Carolina, with nearly 460,000; and Georgia, with more than 425,000.
Government officials had previously estimated that 9.1 million people would enroll for health care insurance during this present enrollment period.
(1/26/15)- Republican Governor Asa Hutchinson of Arkansas has asked the state’s Republican controlled legislature to continue the state’s expanded Medicaid program under the Affordable Care Act for two more years. He also has set up a task force to come up with recommendations for changing or replacing it.
The program, known as the private option, has used federal funds to buy private insurance for more than 200,000 poorer residents through the government’s HealthCare.gov marketplace, instead of adding them to the state’s traditional Medicaid program.
A three-quarters vote of the state’s Republican-controlled legislature is required to approve the program every year.
(1/6//15)- Accenture LLP, the technology consulting firm that took control of the HealthCare.gov website in January to help straighten out the problems associated with the site, announced that it had won a five-year contract worth as much as $563 million to continue the job.
The company’s subsidiary, Accenture Federal Services, which is based in Arlington, Va., will continue to provide maintenance, software development and technology support for the site. The contract is for a base of one year and four one-year options.
The site has been enrolling new and repeat health-care insurance beneficiaries since the second enrollment period began on November 15th. That second enrollment period will end on February 15th.The host-platform will be with Hewlett-Packard Co., which replaced Verizon Communications Inc. in the middle of the first enrollment period.
(12/30/14)- About 6.4 million people selected a health-care plan or were automatically re-enrolled in the first month of the Affordable Care Act’s open-enrollment period, according to Sylvia Matthews Burwell, the Secretary for the Health and Human Services (HHS) department.
This second open-enrollment period will end on February 15, after having begun on November 15. This compares with a total of 5.4 million who enrolled in the inaugural period which ran from October 1, 2013 until March 31, 2015 (6 months vs the present 3 month enrollment period).
This total includes about 1.9 million new consumers who obtained private coverage through the federal exchange. Ms. Burwell told reporters that about 4.5 million people who got coverage through the federal site in 2014 have re-enrolled. About 30% of the re-enrollees had re-enrolled themselves, but the rest were automatically re-enrolled as of December 15, under the terms of the act.
The new enrollment numbers do not include those who signed up through the state run health exchanges. The federal government site, Healthcare.gov serves as the exchange for 37 states. Those who do not get health-care coverage are faced with tax penalties when they fill out their 2014 tax return of as much as 2% of household income.
About 85% of people with marketplace coverage receive federal subsidies to help defray the cost.
(12/24/14)- The U.S .Supreme Court said it would hear oral arguments in the case from Virginia of King v. Burwell that involves the issue under the Affordable Care Act wherein the federal government awards subsidies to millions of consumers who obtained their health-care coverage through Healthcare.gov, which now serves 37 states.
It is estimated that about 4.7 million people receive billions of dollars in subsidies if the coverage resulted from enrolling through the federal exchange. The question does not involve those who bought their coverage through their state exchange.
New York’s Health department reported that more than 225,000 people have newly enrolled on its state’s health-care site. That total includes 83,057 people covered by private insurers and 142,187 by Medicaid. New York enrolled a total of 370,604 people with commercial and nonprofit insurers in the first year of operation.
(12/19/14)- Andrew M. Slavitt, the number 2 official at the federal Centers for Medicare and Medicaid Services reported that more than 3 million people used the HealthCare.gov site from Saturday, December 13 through Monday, December 15, which was the last day for them not to be automatically re-enrolled in last year’s health plan. The exchange received 1.6 million telephone calls in those last 3 days.
The number of individuals selecting plans on the federal health exchange in this latest enrollment period, which began on November 15, already exceeds the number who chose plans in the first 3 months of the original health-exchange enrollment period.
About half of those making selections in the November 15 through December 12 period of time were new customers, and half were renewing coverage or switching to a different health plan.
Administration officials said there would be an opportunity for “special enrollment” period to fill in any gaps in coverage, even if they missed the December 15 cut-off date.
(12/16/14)- The New York State Health Department announced that it would extend its health exchange registration by 5 days until December 20. The extension would be for all those enrolling or renewing health insurance coverage for the second year through the state-run exchange.
The Health Department said that the extension was needed because of the severe snowstorm that hit western New York recently. More than 154,562 people have enrolled through the state health-exchange, since the enrollment period began November 15, for the first time.525, 283 enrolled in Medicaid and 64,675 in the state’s Child Health Plus coverage
(12/15/14)- Only 720,000 people, of the 5 million who enrolled in 2014 had returned to the healthcare.gov site to select a plan for 2015, according to the latest government figures through December 5. About 664,000 more people bought plans on the site for the first time.
If current enrollees do not act by 11:59 p.m. Pacific time, December 15, they automatically will be re-enrolled in their existing plans. Thus insurers won’t get final word on which consumers are switching policies until the deadline has passed. Insurers thus have a very short timeframe between December 15 and January 1to get enrollees billed and plans fully activated.
(12/1/14)- About 220,000 new people signed-up for their health-care coverage on the federal government’s exchange in the first week of the new enrollment period, while about 240,000 people renewed plans bought on the exchange last year.
The deadline for signing up for coverage is February 15, 2015, but current policy-holders have only until December 15 to make changes to their coverage for the new year. If those policyholders don’t come back to Healthcare.gov to see the latest offerings, the government automatically will renew their existing plans.
(11/29/14)- Wyoming’s Republican Governor Matt Mead announced his plan for making the state the 28th to be included in the expanded Medicaid program. His plan would provide Medicaid coverage to about an additional 18,000 low-income residents of Wyoming. Both the state legislature and the federal government would have to approve the plan.
Secretary of health and human services Sylvia Matthews Burwell announced, in a conference call, that more than one million people had submitted applications for health insurance in the first week of this fall’s open enrollment period under the Affordable Care Act, and 45 percent of them had already accepted health plans. More than 3 times as many people have selected health plans in this first week than in all of October and November of the first enrollment period.
The federal website healthcare.gov serves 37 states, with 13 states running their own site. The present enrollment period ends on February 15, 2015. The number of complaints about the operation of the federal site and its malfunctions is down sharply from its initial operation.
(11/18/14)- More than 500,000 people successfully logged onto Healthcare.gov on the first day for enrollment for health-insurance for the second enrollment period under the Affordable Care Act. About 100,000 of them submitted insurance applications, according to officials with the Health and Human Services Department.
There are 2 key dates to keep in mind in connection with this second enrollment period. December 15th is the deadline for existing policyholders who want to make changes to plans in time for next year, and February 15th is when the open enrollment period ends.
Thirty-seven states rely on the federal site, while 13 states and the District of Columbia have their own exchanges.
(11/14/14)- Health and Human Services Secretary Sylvia Matthews Burwell said the administration was estimating that 9.1 million paid-up enrollees would sign up for their health-insurance on the insurance exchanges by the end of 2015 The Congressional Budget Office (CBO) estimated in April that 13 million people would be enrolled in private health plans by the end of 2015.
The open enrollment period will begin on Saturday, November 15th and run for 3 months. If you are receiving a subsidy or tax credit for your health-insurance premiums, you will have to re-enroll and confirm the data you entered during the 1st enrollment period.
(10/30/14)- A new health insurance portal has opened in 5 states as an online marketplace for small business plans under the terms of the Affordable Care Act. The exchange, which was due to open last year, had to be postponed due to technical problems The 5 states that it has opened in are Delaware, Illinois, Missouri, New Jersey and Ohio. The site will be known as the Small Business Health Options Program Marketplace Early Access.
Companies in those states that have fewer than 50 full time employees can start to buy health insurance for them effective January 1, 2015. If the site does not encounter problems, it will open for the rest of the states on November 15. The site will allow employers to create accounts, complete their applications to obtain coverage through the site and upload a roster of employees to be covered.
They will not be able to browse plans or prices until that data is uploaded onto the site next month. They will not be able to open the accounts until November 15.
(10/18/14)- Under the terms of the Affordable Care Act, the cost of the premiums to an employee can not exceed 9.5% of the employee’s annual salary. For an employer with more than 100 employees who work more than 30 hours a week, the penalty will be $2,000 per employee, starting in 2016.
(10/8/14)- The Centers for Medicare and Medicaid Services (CMS) will have to postpone its plan to transfer the health-care insurance exchange to a new hosting service for the 2nd annual enrollment period that begins November 15.
Verizon Communications has been the hosting server site for HealthCare.gov, but the government had signed a contract with Hewlett Packard Co. to host the site for this next enrollment period. The Verizon platform had a series of outages last year that shut the site and affected the federal data hub on which all states rely to transmit information about enrollees’ identity and income. The CMS felt it had not had enough time to thoroughly test the new Hewlett platform.
Verizon brought in additional staff and upgraded its servers to better handle this next enrollment period since its is estimated by the Congressional Budget Office that 13 million individuals will sign up for the insurance in this next period of time for enrollment. That is up from the 8.1 million that enrolled in the exchanges inception, and will have to be done in a 3 month period timeframe this time, down from the 6 months within which enrollment was permitted the first time.
Aaron Albright, a spokesman for the CMS stated that about 75% 0f newcomers to the site will be transferred during peak periods to a portion hosted by Amazon Web Services (AWS). AWS, which is by far and away the largest cloud server hosting system, will be using a more streamlined platform to create accounts.
(10/5/14)- Judge Ronald A. White, of the Federal District Court in Muskogee, Okla. ruled that the federal government could not subsidize health insurance that was bought on the federal exchange under the Affordable care Act. The judge stayed the effect of his decision to allow the Justice Department to appeal the decision.
Judge White based his decision on the fact that the law authorized subsidies specifically for insurance bought “through an exchange established by the state.” The Obama administration has argued that the intent of the law was to allow subsidies no matter if the plan was part of the state or the federal exchange. A Virginia federal court upheld the legality of the subsidies.
A panel of the U.S. Court of Appeals for the District of Columbia Circuit, in the case of Halbig v. Burwell had reached a similar conclusion in July of this year, but the court recently struck down that decision, and the full court will begin a re-hearing of the matter in December. For more on this matter see our item dated 8/12/14 below.
This case, Oklahoma v. Burwell, was filed by the state against the federal government. A fourth case, filed by the State of Indiana and local school districts, is pending in Indianapolis, which plans to hear arguments this month.
(10/2/14)- The Obama administration announced that it will be re-designing the federal health-insurance exchange at HealthCare.gov so that 70% of the consumers will be able to use a shorter, simpler online application when the second annual enrollment period begins November 15th.
The new application can be used only by first time applicants, not by individuals who have previously obtained coverage through this exchange. Applicants will be asked a series of questions to determine whether they should use the old or the new application.
Consumers can see the available health plans without identifying themselves, but will need to create accounts to buy through the exchange.
The Department of Health and Human Services (HHS) announced that most states will have at least one more insurer selling health plans under the Affordable Care Act when the new enrollment period begins on November 15.
33 states out of the 43 where insurers have filed their intentions for the coming enrollment period are set to have a net increase in plans on the exchange, with the number of plans increasing to 316 from the 252 plans offered under the 2014 structure.
13 insurers have indicated that they would pull out of exchanges for 2015 versus the 77 that are planning to enter the process in 2015.
The HHS summary covers the period up through mid-August and doesn’t cover 7 states.
(9/26/14)- Centers for Medicare and Medicaid Services Administrator Marily Tavenner announced that 7.3 million people who had selected health plans through the state and federal exchanges had paid premiums and retained coverage as of mid-August based on reports from the insurance companies.
The Obama administration plans to automatically renew the coverage and tax credits of most of the 5 million people who had obtained their coverage through the federal exchange but individuals who have had changes in their income should renew their health care coverage by re-enrolling again starting with November 15th and ending on February 15th, 2015.
It is estimated that more than 85% of the people who have bought their health insurance under the terms of the act are receiving subsidies in the form of tax credits.
The Obama administration announced that it planned to terminate health insurance for about 115,000 people on October 1 because they had failed to prove that they were U.S. citizens or legal immigrants eligible for coverage under the Affordable Care Act.
At the same time it also announced that they had informed 363,000 people that they could lose financial aid because their incomes could not be verified. Initially the government was unable to verify the income of about 1.2 million people who bought coverage through the federal site.
(9/18/14)- Sylvia Mathews Burwell, the secretary of Health and Human Resources announced that the Obama administration was awarding $60 million in grants to 90 organizations that would counsel consumers on health insurance for the upcoming open enrollment period under the Affordable Car Act that begins on November 15th and runs for 3 months through February 15, 2015.
The initial enrollment period under the act had run for 6 months and eventually saw 8.1 million individuals enroll under the program.
(9/14/14)- Democrat Governor Terry McAuliffe of Virginia, basically conceded defeat in his battle with the state’s Republican House and Senate in his attempt to make Virginia the 28th state and District of Columbia to join in the option for expanded Medicaid program under the Patient Protection and Affordable Act.
The Kaiser Family Foundation estimates that there are now 10.3 million individuals enrolled in the expanded Medicaid program.
Gov. McAuliffe did issue “emergency regulatory actions” that would cover the heath-insurance care for about 20,000 of the state’s residents with severe mental illness and about 5,00 children of low-income state workers. These programs would be paid for with $40 million left over in the state’s present budget, through July 2015. The state’s General Assembly would then be required to extend the programs.
(9/6/14)- Republican Governor Tom Corbett of Pennsylvania became the 9th Republican governor to opt his state into a form of expanded Medicaid coverage under the Affordable Care Act, thus becoming the 27th state to join in this program. Previously, as we noted in our item dated 5/19/14 below, Republican Governor Mike Pence of Indiana chose to have his state join, after initially opposing it. The June 2012 decision of the Supreme Court that ruled the act constitutional, allowed states to opt out of the expanded Medicaid program.
Mr. Corbett’s administration said its deal with the federal government included sweeping changes to the way care was delivered to low-income residents. Pennsylvania’s expanded Medicaid program would broaden its Medicaid coverage to everyone earning up to a third more than the federal poverty level, or around $16,105 for a single adult, or $32,913 for a family of four..
Pennsylvania will now join Arkansas and Iowa in using Medicaid funds to buy private health care insurance for its residents. The federal government will pay 100% of the cost for the expanded program through 2016 and 90% of the cost for the next three years thereafter
The state would be allowed to require its residents with income above the poverty level to pay premiums of up to 2% of their household income, but they could not be quickly removed from participating if they did not promptly pay their premiums.. Participants would pay an $8 copayment if they used emergency rooms for a situation that was not deemed an emergency. Pennsylvania residents who meet the qualifications will get Medicaid coverage starting January 1, 2015, with premium payments beginning in 2016.
Officials in Indiana and Utah are presently negotiating with federal officials from the Centers for Medicare and Medicaid Services to join the expanded Medicaid program. It is estimated the state would have about 500,000 of its residents enrolling in the program
(9/1/14)- Sylvia Matthews Burwell, the new secretary of Health and Human Services has named Kevin J. Counihan (59), who ran Connecticut’s successful health insurance marketplace (healthcare.gov), as the chief executive of the federal market place. He will start his new job on September 8.
The Obama administration has said that most of the 5.4 million people who bought health insurance through the federal marketplace can automatically renew their coverage during the next enrollment period that begins Nov. 15th, but many may want to check their eligibility and recalculate any subsidies that they may be getting.
Mr. Counihan will run the Center for Consumer Information and Insurance Oversight, which regulates health insurance at the federal level under the Affordable Care Act. He will report to Marilyn B. Tavenor, the administrator of the Centers for Medicare and Medicaid Services.
(8/25/14)- The state of Oregon brought suit against Oracle America Inc., and 6 of its top executives accusing them of fraud for failing to deliver a working website under the Affordable Care Act program. The suit that was filed in Marion Circuit Court, claims that fraud, lying and “a pattern of racketeering” by Oracle cost the state and its Cover Oregon program over $240.3 million for a system that never worked.
A breach of contract lawsuit was brought against the company by Oregon two weeks ago in federal court.
(8/16/14)- The administration has hired Mikey Dickerson to lead a new government team that is intended to identify and fix the government’s failing computer software systems and websites, including the health-insurance exchange (HealthCare.gov).
Mr. Dickerson, formerly an executive with Google, will become the deputy chief information officer of the federal government and the administrator of the United States Digital Service Team, a small group of technology experts whose job it will be to fix the federal government’s websites.
The federal government hopes to hire 25 technology experts for this area.
Obama officials have begun the process of removing up to 310,000 people who enrolled through HealthCare.gov un less they can provide documents by September 5, showing that they are U.S. citizens or legal residents.
The Centers for Medicare and Medicaid Services (CMS) will notify the non-responding individual’s insurer to terminate health policies by September 30. These individuals have not responded to previous inquiries about their citizenship or income levels that entitled them to subsidies.
(8/12/14)- The Virginia challengers who objected to the ruling of the Fourth U.S. Circuit Court of Appeals in Richmond, Va. that upheld the subsidization of premium costs for individuals who bought their health insurance on the federal exchange have filed a petition with the U.S. Supreme Court seeking to overturn that decision. The federal government ran all or part of the health-insurance exchanges in 36 states.
The opponents of the ruling had the option of requesting a rehearing before the full Court, but that would have taken more time for review by the lower court before they could appeal the matter to the Supreme Court.
It is estimated that about 4.7 million Americans bought their health-care insurance through federally run exchanges.
On the other hand, the Obama administration plans to request the Second U.S. Circuit Court to reconsider its decision that called the subsidization by the federal government for those who bought their health-insurance on the federal exchange illegal
(8/10/14)- To follow-up on our item on 7/12/14 below, Massachusetts officials said that the state would use a retooled state health exchange for enrollment in its facility for its open enrollment period that will begin on November 15th, under the terms of the Affordable Care Act.
The Massachusetts Health Connector was established under its 2006 health overhaul. Its health insurance exchange faltered as did both the federal and many of the states’ exchanges.
As we noted in the item of 7/12/14, state officials decided to buy new software for its marketplace, but prepared also to possibly switch to the federal exchange. Connector officials hope to be able to enroll 450,000 individuals during this next enrollment period, including those with temporary or legacy coverage, who need to apply for plans that comply with the Act.
(8/7/14)- Lawrence Miller, Vermont’s chief of the state’s health-care insurance exchange, Vermont Health Connect, said it had hired a new company, Optum, to replace CGI, the original contractor for its troubled website. CGI will continue to host the website.
Premiums for health-care plans in California will go up 4.1% on average next year for the 1.4 million residents who chose that state’s coverage under the Affordable Care Act. California did not allow people to keep individual plans issued before the law took full effect in 2014.
Based on figures from 24 states and the District of Columbia, the average premium increase for next year would be about 7.5% according to PwC’s Health Research Institute, a subsidiary of PricewaterhouseCoopers LLC. That figure did not include the new California rate.
(8/4/14)- William T. Woods, a senior official from the Government Accountability Office testified at a House hearing that the federal health insurance marketplace, and its website, HealthCare.gov were over budget and behind schedule because of “new changing requirements” imposed by administration officials.
He warned of “significant risks” in the next enrollment period, which begins November 15. Sylvia Matthews Burwell, the new secretary of Health and Human Services will have her hands full in her new job. Andrew M. Slavitt, the No.2 official at the Centers for Medicare and Medicaid said the agency was changing requirements for its contracts to expand the scope of the work that must be done.
The Government Accountability Office has estimated that through March of this year, the government has made commitments to spend $840 million on the federal health-care insurance exchange. In January the government brought in a new company, Accenture Federal Services to be the lead contractor on the site. The one-year contract was initially valued at $91 million, which was increased to $175 million on June 5.
(7/31/14)- Among the 14 states operating their own health-insurance exchange, two states, Nevada and Oregon, are considering joining the federal exchange. On the other hand, Arkansas is looking to set up its own health-insurance exchange, rather than stay with the federal system.
The federal government must give its approval before a state can operate its own exchange. In seven of the 36 states, the exchange is operated as a formal state-federal partnership, with the state taking on some tasks, but leaving others to be run by the federal government.
(7/24/14)- Two federal appeals courts came to different conclusions in their rulings as to the legality of the federal government’s subsidization of health insurance premiums for individuals who bought their health-care coverage on the federal insurance exchange under the Affordable Care Act of 2010.
By a 2 to 1 vote, a panel of the U.S. Court of Appeals for the District of Columbia Circuit, in the case of Halbig v. Burwell, struck down a regulation by the Internal Revenue Service that authorized the payment of premium subsidies in the 36 states that used the federal exchange. 4.5 million people were eligible to receive these subsidies. The Justice Department said it would continue to pay these subsidies to the insurance companies.
On the other hand the Fourth Circuit in Virginia upheld the subsidies, saying the I.R.S. rule was “a permissible exercise of the agency’s discretion”.
(7/12/14)- As we noted in our item dated 5/16/14 below, Massachusetts state board members of its Health Connector health officials have delayed until their August meeting whether the state can move forward with its reconstructed state-health care exchange or join the federal marketplace at HealthCare.gov.
After its board meeting on Thursday said that, after a successful demonstration of its new software for its site, that federal officials told them to continue the dual approach until the August meeting, when a decision must be made as to which system the state will use.
As we noted in that earlier item, the state received $174 million from the federal government to overhaul its website, and has spent about $57 million so far, including the amount paid to CGI Group Inc (the firm that built the state’s malfunctioning website), according to Glen Shor, the state’s secretary of administration and finance.
(6/24/14)- The results of a survey conducted by phone interviews from April 9 to May 11 with a nationally representative sample of 742 people ages 18 to 64, who bought their own health-insurance on the new exchanges, by the Kaiser Family Foundation indicated that 6 out of 10 were previously insured.
The margin of sampling error was plus or minus 4 percentage points for the full sample.
The survey also found that many of them were unsure to exactly what the insurance covered, nor the amount of monthly premiums that they would be paying. Almost 4 in 10 did not know the amount of their deductible.
(6/17/14)- Federal officials, and Serco, the company hired by the government to resolve inconsistencies between claimed income levels, and the levels shown in official government records used to determine eligibility for subsidies for health-insurance premiums have estimated that as many as two million people show discrepancies.
The government has sent letters out to many of those who obtained their health insurance under the terms of the Affordable Care Act requiring them to submit additional documentation to verify their income, citizenship, immigration status and Social Security numbers, as well as any health coverage that they may have through their employers.
Individuals who do not provide the information risk losing their subsidized coverage, and may have to repay the subsidies next April.
Eight out of ten people who selected health coverage through the health plans under the terms of the act were eligible for subsidies, including income tax credits. The federal government has paid out $4.7 billion in subsidies so far this year, and that amount is expected to grow to $900 billion over 10 years.
(6/15/14)- A federal judge has decided against the legality of a new rule from an Obama administration official that required drug companies to offer certain drugs at discounted prices, saying it had no authority to issue the rule.
Judge Rudolph Contreras of the Federal District Court in Washington issued his decision in late May, and Obama officials may appeal the ruling. The discounts typically range from 20% to 50%.
At issue is a federal program created in 1982, called the 340B program contained in the Public Health Service Act, to limit the prices that drug companies can charge for medications sold to certain hospitals and clinics serving low-income patients. Under the Affordable Care Act the program was made available to many rural hospitals and cancer centers. The discount would not be available for “orphan drugs”.
Some orphan drugs are not used exclusively to treat rare diseases. The Act did not make it clear if the discount would be available when an orphan drug is used to treat a more common medical problem.
The rule at the center of the court case, issued by Mary K. Wakefield, a top federal health official, requires drug companies to provide the discount even if the orphan drug could be used for another common medical problem.
(6/12/14)- With the resignation of Virginia Democrat State Senator Richard L. Saslow, the Republicans in that state’s Senate became the majority party with a 20-19 edge over the Democrats therein. The Republican majority could therefore block the passage of the Virginia budget, which has a deadline of June 30.
The Democratic Governor of the state, Terry McAuliffe had been a strong proponent of expanding its Medicaid coverage as 26 other states have done. With the 20 Republican state senators opposing the expansion, and faced with the budget deadline of June 30, the governor is seemingly stymied in his attempt to get it done.
The Republicans used their majority to call lawmakers back to Richmond, to pass a budget without providing funds for expanded Medicaid in that budget. Once passed by the Senate, the budget then goes on to the House, where the Republicans hold a solid majority. The governor will then have the ability to add amendments to it, which would then force an up-and-down vote by the General Assembly.
Thanks for the response, Allan. No worries. I reached out earlier about a healthcare guide for the uninsured that was recently added to MB&CC. You can take a look here: ndent.
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(5/30/14)- A recent ruling from the Internal Revenue Service stated that large employers who dump their employees from the company’s health-care coverage, and give the employee funding to cover the cost of the premium for the new coverage will be doing more harm than good.
The employee would have to report that payment as income when filing his/her income tax, and the employer may be subject to a tax penalty of $100 a day, or $36,500 a year for each employee who goes into the individual market-place.
The Obama administration announced their position in an authoritative question-and-answer document released by the IRS, in consultation with other agencies. When employers provide coverage, their contributions, averaging more than $5,000 a year per employee, are not counted as taxable income to the employee. That would not be the case if the employer provided the employee with a lump sum to go out and buy private insurance.
The Department of Health and Human Services said it would provide financial assistance to certain insurers who experience unexpected financial losses this year.
(5/24/14)- Nevada’s health exchange board voted unanimously to sever ties with Xerox, which had a $72 million contract to build that state’s troubled exchange. Xerox had been paid $12 million to date on that contract. The state is being sued in a class-action suit by 200 customers of the exchange who said that they paid for coverage but the insurance carrier has no applications pending for them
About 46,000 people had signed up for the private coverage through the exchange as of May, which was far fewer than the targeted amount of 118,000. Nevada will now switch to the federal exchange for which the new enrollment period starts November 15.
The Associated Press has reported that federal prosecutors have subpoenaed state records for a grand jury investigation of Nevada’s failed exchange. Nevada’s governor, Brian Sandoval is one of the few Republicans who embraced both the state-run health exchange, and expanded Medicaid under the Affordable care Act.
About 190,000 Nevadans have signed onto expanded Medicaid in the state.
Oregon was the first state to abandon its own health-care exchange, which was also overrun with problems in favor of the federal exchange. A grand-jury investigation of that state’s failed program is being overseen by the U.S. attorney’s office in Portland.
Oregon had received about $305 million in federal grants to build its exchange, according to the Congressional Research Service, but its system turned out to be unworkable without the help of humans. .In spite of those problems, about 81,000 people enrolled for private coverage, some of which was done using paper applications. Cover Oregon is one of the more notorious failures of the state run systems.
(5/19/14)- Republican Governor Mike Pence of Indiana, who was a member of the Tea Party when he was in Congress, said that he would ask permission to use federal Medicaid dollars to expand the state’s Healthy Individual Plan to cover an estimated 350,000 additional low-income residents.
His plan calls for removing adults who are not disabled from the Medicaid rolls, and instead use the state-run plan, which relies on a mixture of health-savings accounts and private insurance policies with high deductibles. Iowa and Arkansas have similar type plans for which permission has been granted by federal officials. The proposal would need the approval of the department of Health and human Services.
Participants in his plan would require some premium payments from the enrollees. The poverty level for an individual is $11,670. Healthy Indiana uses a mix of state and federal money to cover about 45,000 residents who live below the poverty level but do not qualify for traditional Medicaid
(5/16/14)- Massachusetts health officials announced that they would abandon the state’s problem plagued CGI Group Inc’s built health exchange website, and instead would buy new software from hCentive, a Virginia based company that helped build that state’s health exchange. Massachusetts has paid CGI, the builder of the federal government health-exchange website, $17 million on the $69 million contract.
The state received $174 million from the federal government to overhaul its website, and has spent about $57 million so far, including the amount paid to CGI, according to Glen Shor, the state’s secretary of administration and finance.
As a contingency, the state will also prepare to join the federal insurance exchange, in case the new site is not ready by November, when the next enrollment period begins. Massachusetts had set up its website in 2006 but had to revamp last year to comply with the Affordable Care Act.
The state has put about 190,000 of its residents on temporary Medicaid until it can determine exactly what coverage they are eligible for. The software being installed by hCentive had been successfully installed in Kentucky and Colorado. It has also allowed about 100,000 residents to stay in old subsidized plans that are not compliant with the act, at a cost to the state of about $10 million.
(5/5/14)- The final report from the Obama administration on the federal and state marketplaces set up under the Patient Protection Act showed that there were over 8 million people who had enrolled. Of the 3.8 million who enrolled on the federal exchange, and who voluntarily disclosed such information, 63% were white, 17% were black 11% were Hispanic and 8% were Asians.
2.2 million of the enrollees were in the 18 to 34 years old age category, which represents 28% of those signing up. These numbers were up to March 31, which was the official deadline, but there will be additional people obtaining insurance, since exceptions are being allowed.
From April 1 to 19, another 910,500 people were allowed to sign up. The federal exchange counted up 5.4 million people, as of the end of its deadline. The state exchanges signed up a total of 2.6 million. Administration officials did not have numbers for those who had paid up their premiums.
About 85% of those who chose plans on the exchanges qualified for financial assistance.
(4/27/14)- There were 36 states that used the federal government’s health-care exchange site to enroll people for their health insurance and 14 states that set up their own exchanges to handle enrollments. Some of the states’ systems worked well, while others encountered even more breakdowns than the well-publicized one for the federal government.
Connecticut ran one of the most functional systems of the 14, so much so that Maryland has decided to abandon its own website and use software developed for the Connecticut exchange.
On the other hand, Oregon has decided to abandon its beleaguered website and adopt the federal Healthcare.gov system. Oregon, Hawaii, Maryland and Massachusetts are the states that encountered the most technical difficulties with their health-care insurance exchange websites, while Connecticut’s exchange turned out to be one of the best.
The board of the Oregon exchange met Friday, and along with Democratic Governor John Kitzhaber has decided to make the change in time for this year’s open enrollment period that starts November 15 and runs for 3 months. The Cover Oregon website was built by Oracle Corp. and it is estimated it would cost about $78 million to build a new site, while migrating to the federal technology would cost between $4 million to $6 million.
Oregon had received $305 million in federal grants to build its exchange, according to the Congressional Research Service.
(4/2/14)- It will take many months before officials can “accurately” tally the numbers as to how many enrolled in health-care plans on the federal and 14 state and District of Columbia exchanges, and the various breakdowns of that number, so it is useless at this point in time to even take a wild stab at it.
The Obama administration continues to try to fix some of the shortfalls in the Affordable Care Act, with the latest one being that it would allow some people to receive federal subsidies for health insurance purchased in the private market outside of health insurance exchanges.
Under the new policy, people will now be allowed to sign up for coverage on either the federal or state exchanges and receive federal subsidies “on a retroactive basis,” going back to the date on which they first enrolled in a health plan outside the exchange.
The Congressional Budget Office estimates that four-fifths of people buying insurance through exchanges will qualify for subsidies, with it costing the government an average of $4,700 for “each subsidized” enrollee this year.
(3/31/14)- Administration officials announced that insurance companies could continue to sell health-insurance plans that do not meet the minimum requirements set in the Patient Protection and Affordable care Act until 2016. It was the second time the administration delayed that requirement after insurers cancelled many policies because of the failure to meet those minimum requirements.
Obama officials have previously delayed the law’s requirement that firms with more than 50 employees provide coverage of pay a fee. That rule was supposed to take effect this year, but was first delayed until 2016.
In guidance sent to insurance companies, administration officials said that “C.M.S. will provide consumers who tried to enroll during the open enrollment period, but did not complete the process by (11:59 p.m.) March 31, a limited amount of additional time to finish the application, and enrollment process.”
In cases in which the enrollment period has been extended, the individuals will have 60 days to select a health plan. Those who finish their applications by April 15 and pay their initial premiums will be eligible for coverage starting May 1.
In a separate bulletin, administration officials listed 10 types of special enrollment periods, for people with “complex cases”. Any consumer who comes in after April 1 will have to attest to the fact that they were in line and eligible to continue their enrollment.
Once the March 31st enrollment period expires the enrollment period for 2015 will run from November 15, 2014 to February 15, 2016.
The new guidance also set a limit on consumers’ out-of-pocket costs for health plans in 2015 at $6,600 for an individual and more for families. That is an increase of $250 compared with this year’s plans.
(3/26/14)- Gary M. Cohen, the official in charge of the federal health insurance market-place, and chief architect of federal rules regulating the operations of private health insurance under the new law, announced his resignation from that post. Mr. Cohen said he would be leaving at the end of the month and go back to California. President Obama accepted his resignation, and thanked him for a job well done.
As director of the Center for Consumer Information and Insurance Oversight, Mr. Cohen had worked closely with all parties in the health field and with Congress to help formulate the terms of the law. His position will be filled by Dr. Mandy K. Cohen (no relative), who is now in charge of consumer assistance efforts in the insurance oversight office in the Health and Human Services Department.
(3/25/14)- After several failures, the Arkansas House of Representatives voted to continue allowing the state to use Medicaid dollars to buy private health-care insurance for poorer residents as we discussed in our item dated 2/28/14 below. Arkansas was the first state to offer a “private option” to extend coverage to about 100,000 lower-income residents.
The vote was 76 to 24, just above the 75% needed for passage under the state’s legislative rules. Since the state’s Senate had passed the bill last month, the measure now goes to Democratic Governor Mike Beebe, who is expected to sign it into law.
(3/21/14)- Obama administration officials announced that it would allow consumers to renew health insurance policies that did not comply with the new law for two more years, with renewals as late as October 1, 2016. In addition, the administration said, insurers could continue charging women more than men for those policies and could charge higher premiums based on a person’s health status, in violation of the new law. Thus individuals and small businesses could have noncompliant coverage well into 2017.
According to officials from the Centers for Medicare and Medicaid Services. a total of 943,000 people had signed up for health insurance in February, which was down from the 1.1 million who had signed up in January. That brought the total through February up to 4.2 million. The enrollment period for this year ends March 31, although an exemption will be made for late signees who were affected by the technical glitches that may occur as that date draws close.
Of those who signed up in February, 27% were between 18 and 34, up slightly from the 25% for the first four months of the enrollment period, through January .Of the people who had enrolled for health insurance, 2.6 million were done through the federal marketplace, and 1.6 million were in states running their own exchanges.
California and New York accounted for two-thirds of all sign-ups through February in the 14 states and District of Columbia running their own exchanges. California had 869,000 sign-ups and New York had 244,600 sign-ups.
In the federal insurance market place, Florida has had 442,000 who came on board through February, with Texas having 295,00 and North Carolina having 200,500 signees.
The Affordable Care Act requires all insurance policies that began after September 2010 to cover the older colon-cancer-screening tests with no out-of-pocket costs to patients. If polyps have been found during a screening, some health plans no longer consider subsequent screenings to be preventive, and require a co-pay. Medicare follows similar rules.
The U.S. Treasury Department noted that companies with 50 to 99 employees accounted for 7% of the private sector work force, while businesses with 100 or more employees accounted for 66%. Small businesses with fewer than 50 employees account for nearly 28% of the private work force.
Local governmental agencies would generally not have to provide health insurance to “bono fide volunteers” who work as firefighters or emergency medical technicians.
(3/7/14)- Lawmakers from both parties are objecting to a plan, announced by the Centers for Medicare and Medicaid Services (CMS) officials in January that was aimed at reducing the cost of drugs to the program. The change was part of a broad plan to the Medicare Part D Prescription program that covers about 39 million beneficiaries.
Medicare officials hoped to end, starting in 2015 or 2016, the practice of covering any and all type of antidepressant, antipsychotic or immunosuppressant drugs, except for a few in its formulary for these classes of diseases.
Medicare presently covers about 140 classes or categories. Six of these classes have a “protected status”. Any and all drugs in the “protected status” category must be paid for by the plans.
Many private insurance drug-coverage plans have drug formularies in which the insured has a different co-pay, depending on the fact as to which category the particular drug falls within i.e. generic, preferred or branded.
Federal law prohibits pharmaceutical companies from giving payment assistance to patients insured by federal programs such as Medicare and Medicaid. That law is aimed at preventing the encouragement of unnecessary drug usage. The question therefore arose as to whether or not that law barred drug companies from making co- payments for drug usage for the newly insured who bought health-care coverage through one of the new online exchanges that came into being under the Affordable Care Act.
Since the government is giving subsidies to many of the newly insured, does that prohibition apply to this situation?
Health and Human Services Secretary Kathleen Sebelius ruled that it is not a violation of the law. In a letter to Rep. Jim McDermott (D., Wash.) she stated that this insurance is not a “federal health-care program.
(2/28/14)- Arkansas Republican House Speaker Davy Carter said he planned to schedule another vote, and was confident the private “expanded Medicare measure would eventually pass. The measure has until March 19th to be passed, so it is quite possible that the state will pass its version of the private “expanded” Medicaid option. We discussed this issue in our item dated 2/23/14 below.
California state officials announced that more than 828,000 state residents had signed up for health-care coverage on the state’s Covered California exchange. Californian’s thus account for more than 20% of the 3.3 million people who have enrolled for health-care coverage under the Affordable care Act.
(2/23/14)- The state legislature of Virginia, which has 400,000 low income residents, failed to pass legislation to “expand” its Medicaid program, with the Republican controlled House vote fell 5 votes short of the 75 needed votes, while the Democratic controlled Senate voted in favor of it. The state’s Constitution required a three-fourths majority for passage of the legislation.
There are 25 states that have “expanded” Medicaid, the program in which the federal government pays 100% of the cost for those in the state who are enrolled for the next 3 years, and then 90% of the cost for the next 3 years.
Individuals who are in the expanded program earn too much money to normally qualify for Medicaid in their home state, but are not old enough to qualify for Medicare.
(2/20/14)- The Arkansas House failed to renew the state’s “private option” Medicaid plan that we mentioned in our item dated 2/12/14 below. In addition to Arkansas, New Hampshire may adopt this type of program and Utah and Pennsylvania have already gone this route. This is not the “expanded Medicaid” program that has been accepted in 25 states.
The 100-member House fell five votes short of the 75 needed to reauthorize the plan.
Under the “expanded Medicaid” program, the federal government pays 100% of the cost for 3 years, and then 90% of the cost for new enrollees in those states who earned too much money to be eligible for regular Medicaid, yet not enough to be able to afford health insurance. In the case of New Hampshire, this meant that as many as 250,000 poor people qualified for the private option.
Arkansans who are eligible for the program earn up to 138% of the federal poverty level, of $15,900 for a single person, to get health-care insurance from one of the four companies on the state’s health exchange. Enrollees with incomes between 100% and 138% of the poverty level are charged co-payments, with an annual out-of-pocket limit of $604. The co-payment for a primary care appointment is $8, while it is $10 for a specialist.
Because of a change in the make-up in the Arkansas state legislature, the program which now covers 83,000 may be discontinued. State financing for its costs in the program have to be re-authorized every year, so even with a slight change in the make-up of the legislators the program may be coming to a halt, which will bring in $915 million to the state this year. The state’s Constitution requires a three-fourths vote to gain approval.
(2/12/14)- State legislators in New Hampshire have reached the framework for a bipartisan agreement to expand Medicaid to about 50,000 low income adult residents of the state. Under the pact, the state will use federal money to buy private insurance, similar to the method adopted last year in Iowa and Arkansas.
The agreement will be drafted into a bill, which will probably be voted on in March. Governor Maggie Hassan, a Democrat, praised the deal during her State of the State speech.
(2/5/14)- Do Accountable Care Organizations (ACOs) help curb health-care costs? The latest figures from the Centers for Medicare and Medicaid Services (CMS) leaves that question unanswered.
It was hoped that groups of physicians or hospitals that formed ACOs would both improve the quality of medical services to Medicare patients, while at the same time, reducing the cost of those services to Medicare. If the ACO was able to accomplish this goal, the organization would, in return, receive incentives for doing so.
About half of the original 114 hospitals and doctors’ groups that were formed under the Medicare Shared Savings Program of 2012 were able to slow Medicare spending in their first year, but only 29 of them saved enough to qualify for the bonus payment, according to the latest figures released by CMS.
The 29 ACOs that met the goal during their first 12 months divided $128 million in net savings, while generating an additional $128 million in net savings for the Medicare Trust Fund.-the account that pays for beneficiaries’ hospital, doctor and drug coverage.
An additional 54 ACOs slowed Medicare costs for their patients somewhat, but not enough to qualify for the bonus. More than 360 hospitals and physicians groups have formed ACOs under the program. There are about 5.3 million Medicare beneficiaries covered under the ACO program, according to a statement from the CMS.
Total Medicare spending was $574 billion in 2012.
(1/16/14)- Recently released figures from the Department of Health and Human Services showed that 2.2 million individuals had enrolled in private health-care plans through Medicare.gov and the 14 state run health exchanges, for the period ended December 28, 2013. A separate report indicated that the number of Medicaid eligible individuals had doubled to 1.6 million.
The demographic data in the report indicated that:
· 24% of the enrollees were between the ages of 18 through 34
· 55% were between the ages of 45 through 64
· 7% selected platinum plans
· 13% selected gold plans
· 60% selected silver plans
· 20% selected bronze plans
· 1% opted for catastrophic coverage
· 79% qualified for some federal assistance
Officials still hope to have 7 million enrollees by March 31, 2014. About 54% of the enrollees were female and 46% were males. 56% enrolled through the federal exchange and 44% enrolled through the state and Washington, D.C. exchanges.
California was the state with the most enrollees, namely 498,794, which fell shy of the 611,000 that had been hoped for. Florida had 158,040 and New York came in 3rd with 156,902 enrollees.
(1/2/14)- As of December 24th, 230,624 New Yorkers had enrolled in either private or public health-care insurance, qualifying them for coverage on January 1, 2014, according to New York officials. As of December 30th, that number had grown to 241,522.
Of those enrollments, 175,146 are in private commercial insurance plans, and 66,376 are in the Medicaid plan. The federal government had estimated that 102,500 would enroll in New York by December 31. Enrollment remains open through March 31. About 75% of those enrolling in individual plans on the New York exchange qualified for a subsidy to reduce the cost of the premium. The goal set for March 31 was an estimated 218,000.
Connecticut had 34,295 people enrolled in private plans through that state operate health-care exchange, Access Health CT, as of December 23, according to state officials. This was about 1,000 more enrollees than the goal set for March, becoming the first state to exceed the March estimate.
(12/31/13)- Officials from the Obama administration announced that more than 1.1 million people had signed up for health-care insurance plans through the federal HealthCare.gov exchange through December 24. California officials stated that, as of December 23, more than 400,000 of its residents had enrolled in its state-run health-care insurance exchange.
Roughly, it is now estimated that a total of two million people had enrolled in health-care plans through the 14 state operated, Washington, D.C. and federal exchanges. Although this is short of the hoped for 3 million individuals that Obama officials had hoped for, enrollment is still open for individuals through March, 2014.
(12/26//13)- Obama administration officials announced on the healthcare website that they would extend the sign-up period for consumers trying to buy health insurance past the December 24th deadline if they qualified for a “special enrollment period” if they could show they had tried to enroll, but could not do so because of problems with the healthcare.gov site. The officials did not set a specific timeframe for the extended enrollment.
Consumers who do not qualify for the “special enrollment period”, but who register from now through January 15th will generally be entitled to coverage that takes effect on February 1, provided they pay their share of the first month’s premium before then.
The original deadline for coverage starting January 1, 2014 was December 15, 2013. On November 22nd the deadline was extended to December 23. On December 23 the White House provided a 24-hour grace period to 11:59 p.m. December 24.
If consumers want to plead their case, they can call a special number, 800 318 2596, and explain why they couldn’t complete their application in time. That number will be staffed 24 hours a day, 7 days a week, except for Christmas.
(12/20/13)- The insurance industry’s trade association, America’s Health Insurance Plans, said in a statement that was released on Wednesday, that they would give consumers an extra 10 days to pay their first month’s premiums. Customers will still be required to be enrolled in most places by December 23, although Maryland has pushed that date back to December 27. March 31 remains the last date for most people to obtain coverage for all of 2014 through the federal and state exchanges.
This means that insurers have agreed to cover their customers retroactively if they go to the emergency room or doctor’s office after January 1, but send in their payment by January 10.
(12/17/13)- The federal exchange website has run, without crashing since early December. In the first week of December, about 112,000 people selected plans, compared with about 100,000 in all of November, and only 27,000 in October. Last week, more than half a million people created accounts on the federal website.
Of the 14 states that are running their own websites, as of November 30, California has enrolled 107,087 people, New York 45,513, Washington 17,750 and Kentucky 13,145. The other states have enrolled 43,963.The total enrollment for the 14 states through November 30th was 227,500 people
The federal government has made contractual commitments to spend $677 million on information technology for HealthCare.gov and paid out $319 million through October. About 41% of those who have signed up so far have been found to be eligible to receive subsidies for their premiums and deuctibles
(12/14/13)- The administration announced that health-insurance policy purchasers under the Affordable Care Act will now have until January 5,, 2014 instead of December 31, 2013, to make their first premium payment for their coverage which begins on January 1, 2014.
HealthPocket Inc., a company that compares health-insurance plans for consumers, estimated that the average individual deductible for what is called the bronze plan (the cheapest one) on the federal online exchange was $5,081 a year, which is 42% higher than the average deductible of $3,589 for individually purchased plan in 2013. The study covered 34 of the 36 states covered under the federal online exchange.
There are tax credits available to help cover the insurance premiums for people with annual income up to four times the poverty level, or $45,960 for an individual. In addition “cost-sharing” subsidies to help pay deductibles are available to people who earn up to 2.5 times the poverty level, or about $28,725 for an individual, in the exchange’s silver plan
(12/11/13)- Because 25 states have refused to go along with expanded Medicaid, federal spending will be about $45 billion lower in 2016 according to calculations made by the Urban Institute and the Kaiser Family Foundation.
The Patient Protection and Affordable Care Act sets an annual out-of-pocket maximum of up to $6,350 for individuals and $12,700 for families, after which the insurer would be responsible for the cost. If you are choosing a plan, be very conscious of the co-pay for the drugs in the plan you choose. Also, make sure the drugs you use are included in the formulary of the plan you select.
(11/30/13)- Officials from the Health and Human Services Department announced that there would be a delay for the online enrollment in the Small Business Health Options Program (SHOP exchange), which enabled businesses with less than 50 employees from joining up in 2014, unless they did so through an insurance broker, agent or insurance company.
That date has now been pushed back to November 2014 for coverage that takes effect in January 2015.
“The agent, broker or insurer will help the employer fill out a paper application for SHOP eligibility and send it into the SHOP marketplace”, according to administration officials. The insurer can enroll the employers and determine what premiums they would have to pay.
Some small businesses may qualify for tax credits worth up to 50% of their premium costs, but the credit can be obtained only by plans that are purchase through the small business exchange.
Department of Health and Human Services also announced that Terremark, a subsidiary of Verizon Communications, the contractor that handles the computer servers for the federal health exchange will be replaced in March by Hewlett-Packard.
(11/26/13)- Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services (CMS) announced on Friday that the government would give people 8 more days, taking the deadline up until the 23rd of December, to sign up for health insurance coverage that would take effect on January 1, 2014. The government was giving recognition to the fact that because of the computer snafus and technical glitches in connection with the federal website, the delay was necessary.
Premiums for the coverage would have to be paid by December 31 for the coverage to begin January 1 for the policy to qualify for the program,
The administration also announced a one month delay until November 15, 2014 for the second enrollment period which was to have ended on October 15th under the terms of the Affordable Care Act.
Jeffrey D. Zients, President Obama’s troubleshooter on the federal exchange repair project said that the federal site could now handle 25,000 users at the same time, and would be able to handle 50,000 users simultaneously by the end of this month.
Sara R. Collins, a vice-president for The Commonwealth Fund, a foundation that specializes in health policy said that the 14 states handling their own exchanges had signed up 173,268 people, and that the federal site had signed up 26,764 as of the latest count.
(11/24/13)- Although the Republican governor of Alaska favored his state’s entry into the expanded Medicaid program the legislature refused to go along with him. The number of enrollees in the health insurance exchanges continue to lag expectations, the same is not true for those entering the expanded Medicaid program.
The administration announced that 396,261 individuals have enrolled in expanded Medicaid, which is far in excess of the anticipated number.
(11/14/13)- A new Kaiser Family Foundation state-by-state analysis estimates that 17 million people nationally will be eligible for tax credits under the Affordable Care Act (ACA) next year if they purchase coverage through new health insurance marketplaces. This includes 2 million in Texas, 1.9 million in California and 1.6 million in Florida -- the three states with the largest number of residents eligible for tax credits.
Another problem has surfaced in connection with the interconnect ability of the 36 federally operated health-insurance exchanges and the 14 state operated exchanges. The federal website, HealthCare.gov was intended to be a gateway to Medicaid allowing eligible Medicaid beneficiaries to pass from the federal site directly to the state site to enroll there in one step.
That has not transpired since the federal government has been unable to transfer its files to the state Medicaid programs, so that entryway has been closed for the last 6 weeks. This is true even for those states that have opted for expanded Medicaid.
Many people going to the health exchanges do not know they are even eligible for Medicaid or for tax credits to subsidize the purchase of private insurance on the exchanges. As things now stand, a state pays anywhere from 27% to 50% of Medicaid costs. Under the expanded Medicaid program, the federal government will pay 100% of the cost for the next 3 years, and 90% of the cost for the next 3 years.
(11/10/13)- The Patient Protection and Affordable Care Act assesses a levy of $63 on each person covered in a health plan, which goes into a fund to compensate the health insurance companies that end up paying big medical bills for new customers who buy their insurance on the government exchanges.
The levy is applied to spouses and dependents, as well as to the policy-holder.
Kaiser Health News, a nonprofit news organization reported that the government intends “to propose in future rulemaking to exempt certain self-insured, self-administered plans from the requirement to make reinsurance contributions for the 2015 and 2016 benefit years.” This exemption would apply to unions and some businesses.
(11/8/13)- The Department of Health and Human Services issued a ruling that copayment assistance drug cards can continue to be used under the Affordable Care Act, and usage of these cards or coupons is not to be considered an illegal rebate. Pharmaceutical companies are contributing $85 to $90 billion in fees, drug-price discounts and other givebacks under the law, according to Prevision Policy LLC, a health-policy consulting firm.
Drug-payment assistance cards and coupons help offset copayment and co-insurance for those who use these items, and thus help to reduce the cost to the holders. You may argue that the rest of us, in turn are the ones who are really paying for it, but I believe the benefit to the lower income individual outweighs the ultimate cost for the rest of us.
(11/5/13)- The latest figures through October 25 indicate that 700,000 people had applied for health-insurance, with about one-half coming from the federal site and the other half from the state-exchanges.
Julie Batile, a spokeswoman for the Centers for Medicare and Medicaid Services, which has responsibility for the federal website stated: “All of that is covered with our contractual obligation that already exist, that $630 million number.”
The Obama administration assigned new responsibilities to Quality Software Services, a unit of UnitedHealth Group, saying it would be the general contractor, coordinating work on the project. CGI Federal, a unit of CHI Group has been the lead contractor for the project.
(10/30/13)- One of the major problems afflicting the federal health care insurance exchange is that there are at least 55 separate contractors reporting to the Department of Health and Human Services. Many computer experts feel that the department did not have the technical expertise to oversee such a project.
Thus, an outside coordinator, Jeffrey D. Zients has now been brought in by President Obama to oversee the operational capability of the federal health-care exchange insurance site.
It is estimated that the computer project has cost at least $400 million up to now, with at least another $500 million having to be spent before it can become fully integrated with the needed databases from the federal government.
officials announced that people won’t have to pay a tax penalty in 2014- which
starts at $95,or 1% of taxable income-if they sign up for health-care coverage
by March 31.
With President Obama conceding that there have been numerous snafus in the federal computer system for its health-care exchange enrollment, the promise has been made that it will be corrected by the end of November.
(10/25/13)- Ohio became the 25th state plus the District of Columbia to accept expanded Medicaid coverage, according to the Kaiser Family Foundation. Republican Governor John R. Kasich, who was one of the leading opponents of the Affordable Care Act, took the issue to the 7 member state Controlling Board to release $2.5 billion in federal funds sent to the state for the expansion, after the Republican legislature refused to go along with it.
The 5-2 vote will allow 275,000 Ohioans who previously were not eligible for Medicaid to be covered by the program. A budget was sent to the governor by the General Assembly that forbade Medicaid expansion without lawmaker’s approval. Mr. Kasich vetoed that item.
Under the act, the federal government will pay 100% of the additional cost for Medicaid expansion for the first 3 years, and 90% of the cost for the next 3 years.
(10/22/13)- Federal judges in Washington, D.C and Virginia will consider whether or not the language in the Affordable Care Act allows subsidies to be paid to help reduce the premiums paid by low income earners who purchase their health-care insurance from an exchange set up by the federal government in states that did not set up such marketplaces. 14 states and the District of Columbia have set up their own exchanges, so the question does not pertain to these jurisdictions.
The act states that people qualify for subsidies if they obtain health insurance through an exchange “established by the state”. Thus should the subsidy also apply to insurance purchased through an exchange set up by the federal government for the state?
(10/21/13)- According to data compiled by the Wall Street Journal, at least 38,000 people have signed up for new health care plans in the 14 state-run exchanges that opened on October 1. The federal government, which is running the exchanges for 36 states said that it would not release enrollment data until November.
Of the 14 states that reported numbers, Kentucky led the way with 9,500 enrollees. The Congressional Budget Office has estimated that 7 million people will enroll in a health plan from one of the exchanges set up under the Affordable Care Act
New York state said last week that it had 40,000 completed applications, putting it atop that list.
5.2 million people who won't qualify for Medicaid or Subsidies for private insurance live in the 26 states not expanding Medicaid under the Affordable Care Act.
Q: What is the
A: It is a $63 tax assessed on nearly every health insurance plan enrollee for the next three years. The money collected is then used to help insurers in the individual market with high-cost cases that reach beyond a catastrophic cap. The fund would reimburse insurers for 80 percent of costs for claims between $60,000 and $250,000 per person.
(10/16/13)- One of the biggest complaints being voiced in connection with the federal health exchanges is that it requires you to register before you can view the different health-plans that are available and compare them. This problem has now been corrected, and you can now view the different plans being offered without having to first register.
We at therubins recently received the following e-mail from Jeffrey Redd, an Outreach Director and have reprinted that email below since we know the topic is of great interest to many of our viewers
Hello, my name is Jeffrey Redd.
I was doing some research about healthcare, insurance, and what the future brings. I saw you mention Healthcare.gov along with a few other great places on http://www.therubins.com/index.htm.
Thank you for mentioning them. The information they provide the public is exceptional.
I put together some data, and information in regards to substance abuse, and mental health treatment. It is an extremely important aspect of
healthcare, but for some reason is not talked about nearly enough. I wanted to see your thoughts, and if possible help me spread the word. You can see it here: http://www.quitalcohol.com/health-insurance-and-addiction.html
Let me know your thoughts, and thank you very much for your time. Take care.
(10/13/13)- When you purchase your health-care insurance on one of the exchanges, the exchange will verify your income by checking your tax return from last year, as well as your present income. If your self-attested income varies by more than 10% from this amount, you will be asked to provide additional documentation to verify the amount.
Whether or not you pay full price or qualify for a premium tax credit depends on your modified adjusted gross income on your latest tax return. If your household’s modified adjusted gross income is from 100 to 400 percent of the federal poverty level ($11,490 to $45,900 a year if you are filing an individual return and $23,550 to $94,200 for a family of four), you may be eligible for a premium tax credit.
Your adjusted gross income is found on line 37 of your income tax return form, but you must add back in your dividends, interest income, Social Security income and retirement account withdrawals. You also must add in any income from a dependent who has to file his/her own income tax return
(10/7/13)- One of the least discussed items in the Affordable Care Act is the provision calling for a government-funded test authorizing Medicare to set up pilot ACOs. More than 250 health systems have signed on since 2011, covering more than 4 million Medicare beneficiaries.
It is estimated that the sickest 1% of the population cost the medical system about 22% of health spending.
Medicare automatically assigns patients to an ACO, whether they like it or not, if they get most of their primary care from a physician in that ACO. If a patient goes outside the assigned one, the assigned ACO picks up the cost for that treatment even though it had no control over the treatment. Medicare will retroactively reassign a patient to another ACO if the patient, on a quarterly basis uses an unassigned ACO, more than an assigned one.
Under federal rules, if a Medicare ACO meets 33 quality criteria, and lowers average patient cost below an assigned benchmark, it splits the savings with Medicare. Medicare calculates the benchmark using a health group’s historic costs.
Gary M. Cohen, 58, is the director of the Center for Consumer Information and Insurance Oversight, and he is the official in charge of supervising the new health insurance marketplace set up under the terms of the Affordable Care Act. The federal government is running 36 of the exchanges by itself.
He is a graduate of the Fieldston School.in the Bronx, Brown University and Stanford Law School. He was a litigator at Keker & Van Nest, a San Francisco law firm, for 16 years. He also worked at the California Public Utilities Commission and the state’s Department of Insurance.
Even though you must enroll by December 15th for coverage beginning January 1, 2014, the exchanges will be open for enrollment through March 31, 2014.
(10/3/13)- The site, HealthCare.gov, encouraged people to “connect” via Twitter, Facebook and Youtube, and required users to have an e-mail address in order to sign up. It provided a phone number if you wished to call, but there was a long delay in getting the call answered.
If you were able to get onto the site its design and aesthetics were excellent.
You can use your smartphone to get onto the site and register.
(10/1/13)- Obama administration officials announced that the health-insurance market place for small businesses would have to delay its opening by a month to November 1, 2013. The individual health-insurance exchanges will open today as planned, but because of soft-ware snafus, not everyone will be able to enroll online starting today.
For those wishing to enroll, but unable to do so online, the individual will either have to download a printable form, of go to an insurance agent who is licensed to enroll applicants in a plan..
At the same time the administration did also announce that all functions for the Small Business Health Option Program Marketplace will be available in November, and if employers and employees enroll by December 15, 2013, coverage will begin January 1, 2014.
(9/27/13)- The ad campaigns, both for and against the new health care law, are in full swing as we approach the beginning of the enrollment period for health-care coverage under the Patient Protection Act. The federal government will be the sole operator of the health-care exchanges in 36 states. 14 states and the District of Columbia will operate their health-exchanges in conjunction with the federal government
Political groups have spent roughly $500 million since the law was passed either in favor or in opposition to the act according to Kantar Media, an ad-tracking unit of WPP PLC. So far, the majority of spending has been done in opposition to the law.
(9/12/13)- California officials said that the state will be able on October 1 to enroll its residents online in a health-insurance plan set up under the terms of the Affordable Care Act. Dana Howard, a spokesman for Covered California, the agency operating the exchange in the state in which individuals or small businesses can select and enroll in a plan.
Mr. Howard said, exchange officials had completed test of the online system, including creating accounts, selecting plans and assessing eligibility for subsidies
(9/6/13)- The National League Football team the Baltimore Ravens, the winner of last year’s Super Bowl, will help to promote the word about the state of Maryland’s new health-care- insurance exchange which was created under the terms of The Patient Protection and Affordable Care Act (PPACA).
The Obama administration had hoped that the league as a whole would help to promote the law, but several of the team owners had objected to doing same, after being warned by some Republican lawmakers to all sports leagues to avoid doing so.. About 800,000 or 14% of the state’s population of 5.8 million is uninsured.
Former President Bill Clinton has also been in the forefront as an advocate for the health-care law.
Fourteen states and the District of Columbia are running their own health-insurance exchanges, while the federal government will be operating the exchanges in 36 states. People can start signing up for the coverage beginning October for the coverage that will start January 1, 2014.
Danielle Davis, communications director for Maryland Health Connection, said ads will be placed on a Raven related radio show and website.
(9/5/13)- The Michigan State House, by a bipartisan vote of 75-to-32, gave final approval to a measure that would add the state to the expanded Medicaid coverage under the Patient Protection Act. In doing so, it is estimated that almost a half-million more low income adults would be eligible for coverage.
The State Senate narrowly passed the measure last week, with the blessing of Republican Governor Rick Snyder, who had been a vocal opponent of the law. Under the terms of the act, the federal government will pay the entire cost of those low-income individuals who would now be covered under Medicaid, and 90% of the cost for the following 3 years
(8/18/13)- The limit on out-of-pocket medical costs, including deductibles, co-payments and prescription drug costs was not supposed to exceed $6,350 for an individual and $12,700 for a family in 2014 under the terms of the Affordable Care Act of 2010.
It has come to light however that a grace period has been extended until 2015 under a ruling that was contained in the Labor Department's Web site in the "frequently asked questions about Affordable Care implementation".
Under the ruling, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, there could be a $6,350 limit for doctors' services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a prescription benefits manager.
Some consumers may even have to pay more, as some group health plans will not be required to impose any limit on a patient's out-of-pocket costs, it will not have to impose one in 2014.
The law also requires coverage of dental care for children, but these benefits can be offered in a separate health plan with its own limit on out-of-pocket costs.
(8/13/13)- Oregon, which is one of 14 states that will operate its own health-insurance exchange, will open for business on October 1, but consumers will not be able to access it online. Officials at Cover Oregon, as the exchange has been called, should be able to go online to enroll by the end of the month.
For the first couple of weeks of the enrollment period, consumers in Oregon will have to visit an agent's office, or find one willing to come to their house to enroll. Cover Oregon said that it has trained about 1,000 agents and 800 other people to help people enroll.
Officials from Oregon give as the reason for the delay is that they wanted to test the system properly, over a sufficient period of time to make sure that the system worked properly once it started up.
The District of Columbia will operate its own health-insurance exchange.
(8/10/13)- A provision of the Affordable Care Act of 2010 that went into effect last year, penalizes acute care facilities for excess re-admissions of Medicare patients.
The maximum penalty is 1% of a hospital's base Medicare payment, but hat will increase to 2% on October 1, and go up to 3% by fiscal 2015. The penalties are based on the number of patients above the national average who are re-admitted to an acute-care hospital due to heart failure, heart attack or pneumonia and then re-admitted with 30days.
An estimated $227 million in fines will be levied this year by Medicare against 2,225 hospitals starting in October. Last year, 32,214 hospitals were fined a total of roughly $280 million.
(8/9/13)- Under the terms of the Affordable Care Act, a tax would be imposed starting in 2018 on owners of health insurance plans that cost above a certain threshold. The purpose of this so-called "Cadillac Tax" was to make the consumer more aware of exactly the costs involved in their medical treatment.
The tax would be imposed starting in 2018 for plans that cost the employer above $10,200 annually for individuals and $27,500 for family plans, with slightly higher cutoffs for retirees and those in high risk professions like law enforcement. The tax would be 40% on the excess amounts.
Municipal and state unions are mobilizing their resources to deal with this issue since many of their employers have plans in which the government pays a large, if not all of the costs for the individuals health insurance.
(8/2/13)-Individuals earning up to 400% of the poverty level can get federal subsidies to help with the cost of their health insurance premiums, but only if the policy is bought through the newly created health exchange.
This year, 400% of the poverty level is $45,960 for an individual, and $62,400 for two-person households.
Some cities may also provide moderate monthly stipends to help retirees with the cost of their premiums for their health insurance purchased through the new health insurance exchange market.
For taxpayers who itemize their deductions, medical expenses paid for themselves, spouses and dependents will have to exceed 10% of adjusted gross income unless the person paying the bill are 65 or older as of December 31 this year. In that case the threshold will remain at 7.5%
(7/27/13)- As of the latest count, the federal government has full control over the health-insurance marketplace in 19 states, while 17 of the states and the District of Columbia will manage their own exchanges. The health-insurance exchange in 15 of the states will be joint ventures between the federal and state governments.
Getting the computers to communicate with each other will be just one of the many problems the new systems will be faced with once the provisions of the new law come into affect.
(7/24/13)- Individuals buying health insurance on their own in New York State will see their premiums fall next year by about 50%, according to state officials. State insurance regulators say they have approved rates for 2014 that are at least 50% lower on average than those currently available in the state.
Beginning in October, individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly. With federal subsidies costs will be even lower.
(7/21/13)- Equifax Workforces Solutions, a unit of Equifax Inc. has been hired by Obama officials to help verify the incomes of people who apply for federal subsidies to buy insurance under the new health law.
Subsidies, in the form of tax credits, will be available to millions of low and moderate income people who are not eligible for Medicaid, and have not been offered affordable coverage by employers.
The subsidies will average about $5,000 a year. In some cases, the insurance provider can rely on what the consumers say about their income and employer-sponsored coverage if such information cannot be obtained from the employer or other sources.
Contract documents show that Equifax must provide income information "in real time", usually within a second of receiving an inquiry from the federal government. Equifax says that much of its data comes from information supplied by the employers and updated each pay period. It is incumbent on Equifax to make sure there is no fraud involved in the data it uses.
Equifax is also responsible for providing the information about employer sponsored plans and how much the employees pay for it.
The government had awarded an earlier contract to the American unit of the British company Serco Group to provide "eligibility support services' to health insurance exchanges around the country.
(7/5/13)- U.S. Treasury officials announced in a blog, on the department's website, that Obama officials would delay enforcing the provision in the Affordable Care Act for one year that required employers of 50 or more employees who worked 30 or more hours to provide healthcare coverage for their workers or face a penalty starting in 2014.
The penalty is a fine of $2,000 per employee.The decision reflects pressure from companies in the restaurant, retail and agriculture industry, who had cited several practical difficulties posed by the law's requirements.
The provision in the law that requires individuals to carry health coverage or pay a fine starting in 2014 remains in effect. The fine will be assessed when the individual files his or her 2014 income tax return.
(6/27/13)- Kathleen Sebelius, the secretary of health and human services announced that a call service and web site would be available 24 hours a day to help prospective purchasers of health care insurance make decisions needed to be made to comply with the Patient Protection Act of 2010.
The call center number is 800 318 2596 and the web site is www.healthcare.gov . The web site will provide information promoting the new health care law, and it will describe the different options available in the newly established health exchanges.
Consumers can file online applications starting October 1, with coverage beginning January 1, 2014.
The Congressional Budget Office (CBO) predicts that 7 million people will buy private insurance next year through the new exchanges, while 9 million people will gain coverage through expanded Medicaid coverage in those states that applied for the expansion option..
The CBO estimates that the number of uninsured, which is now at 56 million, will be reduced to 25 million under the new law.
(6/11/13)-Under the terms of the Patient Protection Act, employers with 50 or more full-time equivalent employees will need to offer health insurance to all their workers who average 30hours or more a week.
In addition, employers must not ask employees to contribute more than 9.5% of their income to health-insurance premiums. Otherwise the, employers could face penalties. If the employee does not sign up for health-insurance coverage under the company's plan, the employer will not be penalized.
(6/8/13)- The Patient Protection Act requires that 10 essentials be included in all health-insurance policies sold in the health exchanges set up under the law. These include maternity care, substance abuse and mental-health services and prescription-drug coverage, which aren't included in standard individual policies today.
In addition, plans can't exclude pre-existing conditions. Under the law, annual out-of-pocket expenses are capped at $6,350 for a single person, and $12,700 for a family.
Open enrollment will begin October 1 and run through March 31. After that, open enrollment for 2015 will run only from October 15 to December 7, 2014.
Through tax credits, the government will help fund some of the premiums for those whose household income is up to 400% of the federal poverty level. That's $45,960 for an individual and $94,200 for a family of four, based on 2013 numbers.
(6/1/13)- One of the provisions of the Affordable Care Act of 2010 that does not come into effect until 2018 is now coming into the limelight since it can be very costly to companies that provide so called "Cadillac health plans" for its employees.
Under the terms of the law, an employer offering a plan that costs more than $10,200 for an individual and $27,500 for a family would typically pay a 40% excise tax on the amount exceeding the threshold.
In order to lower the impact of this provision, employers could raise the deductible amount its employees would have to pay, before the company's insurance kicks in. Companies have in fact been doing this for the last several years. At last count about one third of workers are in plans with a deductible of at least $1,000.
More and more employers are offering health savings plans to their employees which have lower premiums for its members, but much higher deductibles.
(5/30/13)- California is one of the key states participating in the health-insurance marketplace set up under the Patient Protection Act. Initial indications are that 13 or 14 states will set up their own market-place, with the rest of the states therefore depending on the federal government to set up the program within their borders.
Covered California, the agency set up by that state to create its online market place for health insurance estimated that about 2.3 million residents of that state would enroll in the program by 2017.
The agency said that its initial indication is that the average premium will be $321 a month for its silver plan, which falls in the middle of the spectrum of the plans being offered. State regulators will review the rates, and many people will receive subsidies, depending on their income levels.
So far, 13 insurers have agreed to have plans available on the exchange for Californians. Blue Shield of California said its average premium for preferred-provider organizations in 2014 would be around 13% higher than its current average for individual PPO plans. UnitedHealth Group Inc., Aetna Inc. and Cigna Corp., the nation's 3 largest health-insurers have no present plans to participate in the California program.
The insurers participating in the program said they would limit the choice of medical professionals and medical facilities that its members will be able to use.
Two of the states that initially indicated that they would set up t heir own health-insurance exchange, Idaho and New Mexico, are now asking the federal government for help because they can't have their own exchanges set up by October 1, the cut-off date for having the exchange in place.
(5/12/13)- The Affordable Care Act that goes into effect January 2014 requires all employers who have 50 or more employees who work 30 hours or more a week to have health care insurance for their workers. If they don't, the employer faces fines starting at $2,000 per worker annually.
Some employers are considering cutting back on the number of hours that their employees work to below 30 hours a week, so that they would not be covered under the act.
The Congressional Budget Office estimates employers will pay around $106 billion in penalties between 2014 and 2022 for not meeting the law's insurance requirements.
(5/5/13)- Even though Republican Governor Rick Scott had reversed his position, and had agreed that it would be best for the state to accept the expanded federal program for Medicaid recipients, the legislature refused to go along with him on this issue. Under the expanded program the federal government would have financed the full cost for the first 3 years, and 90% of the cost thereafter.
Florida has one of the highest rates of uninsured people, so that the state's emergency rooms will have to bear the brunt of continuing to be the primary care medical facility for about 1 million uninsured residents who live there.
It is estimated that the state will lose about $1 billion in funding in 2014 by not joining in the expanded Medicaid program.
At last count, 33 states have opted against running their own health insurance exchange, so that the federal government will be operating the exchanges in those places.
(3/29/13)- Republican Governor Bill Haslam of Tennessee announced that he would not expand Medicaid coverage in his state, and thus he joined 18 other Republican governors who also refused to go along with the plan.
When the Supreme Court upheld the constitutionality of the Affordable Care Act, it also declared that the states must be given the option of joining in the expanded Medicaid portion of the law. Even though the federal government will pay for 100% of the increased cost for the expansion from 2014 to 2016, which will decrease to 90% in 2020, the governor refused to join the plan, even though there are about 175,000 residents of the state who might become eligible for coverage..
(3/28/13)- Health and Human Services Secretary Kathleen Sebelius acknowledged that cost could rise in the individual health insurance market, particularly for men and younger people, because of provisions in the Patient Protection and Affordable Care Act due to take effect January 1, 2014.
The law eliminates discriminatory market practices that have imposed higher rates on women and people with medical problems, and limits how much insurers can charge older people.
While the changes will lower the costs for women, older beneficiaries and the sick, men and younger, healthier people are likely to see higher rates as insurers try to hedge their risks.
(3/20/13)- A provision in The Patient Protection and Affordable Care Act that requires an employer to pay a fee of $63 for each employee covered under the act is attracting a great deal of media attention.
It is estimated that companies and other plan providers will pay about $25 billion over three years to create a fund for insurance companies to offset the cost of covering people with high medical bills.
Several of the country's largest employers have asked federal regulators to exclude or shield their insurance recipients from the fee, since it subsidizes individually purchased plans that won't cover their workers.
Insurance companies argue that the fee is necessary to prevent rates from skyrocketing when insurers get an influx of unhealthy customers next year. The fee will be smaller in 2015 and 2016, though regulators haven't set those amounts yet.
(3/10/13)- Under the terms of The Patient Protection and Affordable Care Act, Medicare will cover an annual wellness visit that includes detection of "cognitive impairment". Once diagnosed, patients can be helped with family support, medication management and brain games to help delay further decline.
For more information on the Medicaid terms of the act, please see our article Medicaid Eligibility
(2/28/13)- When the Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act, it also ruled that the expansion of Medicaid under the act was an option, not a requirement of the states.
At the time of the ruling several state governors who had opposed the constitutionality of the act stated that they would not expand coverage of Medicaid, even though the federal government would pay the entire cost of the expanded coverage for the first 3 years, and 90% of the coverage thereafter.
As the deadline approaches for declaring their official stands on the matter, seven Republican governors now are cautiously moving to expanding Mediciad coverage in their state. In Florida, Republican Governor Rick Scott has reversed his position and announced that he would favor expansion of coverage in his state. He joins governors from Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio in now favoring expansion of coverage.
Nationally, Medicaid now covers about 60 million people, and the Congressional Budget Office (CBO) estimates that 17 million more people could be enrolled, if all states took the expansion option.
Twenty-two states have accepted the expansion option, 17 have opted against it, and 12 have not announced their position on the matter, according to Avalere Health, a consulting firm. Governor Scott had previously been one of the most vocal opponents of having a state expand its Medicaid coverage.
(2/22/130- Federal officials issued a final rule defining "essential health benefits" that must be offered by health insurers under the Patient Protection and Affordable Care Act starting next year. The rule would require insurers to cover treatment of mental illnesses, behavioral disorders, drug addiction and alcohol abuse.
Kathleen Sebelius, the secretary of health and human services, said that in addition to the millions who would gain access to mental health care, 30 million people who already have some mental health coverage will see improvements in benefits.
The rule says the new health insurance policies can be offered at four levels of coverage. Minimum benefits will vary from state to state, as each state will have its own benchmark plan.
Aetna Inc. has said it will probably participate in 15 exchanges, while Humana Inc. stated it would likely participate in about 10 states. Cigna Inc. has indicated that it would participate in approximately 10 states also.
Blue Cross and Blue Shield are expected to participate widely in these new health-insurance exchanges, while WellPoint Inc. said it expected to participate in 14 states.
Eighteen states have agreed to set up their own state operated health-insurance exchange as required under the Patient Protection Act. On the other hand there are around 197 million people who live in states that have chosen not to run their own exchanges.
About 18.3 million of the 197 million have no health insurance and have incomes that could qualify them for subsidies to help them pay their premiums for the coverage.
The U.S. Department of Health and Human Services is poised to run exchanges on behalf of these remaining states. Federal officials expect about half of these states to run the exchanges in partnership with the federal government. They have until February 2013 to make this choice.
Five of the states that will run their own exchanges have Republican governors, who said they oppose the law, but would prefer to retain control of them on the state level rather than have the federal government involved in them.
The six are
December 14th is the deadline for states to tell the federal government if they intend to establish their own insurance exchanges. Gary M. Cohen, a federal health official said that the federal government had received applications from 14 states that want to run their own exchanges. The states will have until February 14th to send a "letter of intent", if they want to establish the exchange in cooperation with the federal government.
No phased in expansion of Medicaid eligibility will be allowed.
The letter of intent should state whether the exchange will be operated by the state alone, by the state in conjunction with the federal government, or allow the federal government to operate the exchange by itself.
Under the Patient Protection and Affordable Care Act, the exchanges are supposed to be ready to start enrolling people in October 2013.
Republican Governor Bob McDonnell of
If the letter of intent is sent to the federal government stating willingness to set up an exchange in partnership with the federal government, the state will have until February 15th to do so. If the state intends to set up the exchange on its own, it must now do so by December 14th.
Under the terms of the Patient Protection Act, starting in 2013, the maximum that an employee can contribute to his/her flexible spending account (FSA) is $2,500
The declaration of intent need only be a one or two page letter affirming the state's intent to set up its own health insurance exchange or to do so in partnership with the federal government. Those that want to run it in partnership with the federal government will have until February 15th to file the application. That letter of intent does still have the November 16th deadline.
At last count 15 states and the District of Columbia had created the framework for the exchanges, with 3 others having committed to running an exchange in partnership with the federal government. The Republican governors of Arizona, Idaho, New Jersey, Virginia and Tennessee stated that they would defer acting until after the election, which has now passed.
Families with incomes up to 400% of the poverty level will receive subsidies from the federal government to help them meet their premium requirement for the plan they choose under the state's insurance exchange.
If the state does not set up an insurance-exchange, the federal government will set it up in the non-complying state, and for many state-righters, that is not too pleasant a choice to be faced with..
Under the terms of the law, individuals and small businesses must have health insurance or they will be subjected to levies when they pay their income taxes starting in January 2014.
The marketing of the health plans is
scheduled to begin in October 2013 for coverage starting
If an individual or company with more than 50 employees fails to do so, they will be subject to fines through a tax penalty. People with incomes between 133% and 400% of the federal poverty level can get federal tax subsidies though their insurance exchange.
Only 13 states and the District of Columbia have formally committed to run their own exchanges. The Republican governors in Alaska, Florida, Louisiana, Maine, South Carolina and Texas have said hat they would not set up health insurance exchanges in their states, according to the Kaiser Family Foundation. Twenty-two states have stated that they are still exploring the idea.
The federal government will pay the cost of setting up and running the exchanges.
(9/24/12)-The non-partisan Congressional Budget Office (CBO) estimates that nearly 6 million Americans will face a tax penalty under the terms of the Patient Protection Act by 2016, when the penalty phase becomes fully operational. The amount of the penalty will be based on income.
Shortly after the law was passed the CBO estimated that 4 million Americans would be affected by the tax penalty terms of the act. The budget office estimates that the penalty will cost about $1,200 on average in 2016.
Under the terms of the act almost every legal resident of this country will be required to have health insurance in 2014 or face a tax penalty. There will be exemptions for fainancial hardship, religious objections and certain other circumstances.
States will be setting up health insurance exchanges, but if they fail to do so, the federal government will set up the site. Subsidies will be available to low income individuals under the terms of the law.
(9/19/12)- The percentage of people ages 19 to 25 who lacked health insurance fell to 27.9% from 33.9% in 2010, according to the data from the National Health Survey, which is a federal funded study. This translates to 1.6 million fewer uninsured young people from the prior year.
For the next age group-those 26 to 35 years old-the percentage of the uninsured rose. Medical economists attribute the decline to the provision in the new health care law that extends coverage to the age of 26 under their parent's health care coverage insurance plan.
The share of all Americans without health insurance stood at 15.1% in 2011 or about 46 million people, according to the Centers for Disease Control and Prevention. The percentage of uninsured stood at 16% in 2010.
(9/10/12)-There are 1.8 million nursing homes in this country. 31.5% of Medicaid's $400 billion in shared federal and state spending goes to long-term care for the elderly and the disabled.
To be eligible for Medicaid, a person typically can have no more than $14,800 in assets. New York has the biggest Medicaid budget of any state at $54 billion, and spends about 41% of it for long term care, almost half on nursing homes.
By 2015, New York will start requiring some 78,000 nursing home residents to choose one of several managed care plans or be enrolled randomly in one of them.
Children could be liable for Medicaid expenditures for their parents under pending new laws. A 2009 analysis by the Kaiser Foundation found that direct out-of-pocket sending by individuals and families accounts for 22% of the $178 billion spent on nursing homes.
(8/3/12)- The rebate checks that were called for under the terms of the Patient Protection and Affordable Care Act are in the mail to some healthcare policyholders.
Under the terms of the law, insurers are required to give out annual rebates by August 1, if less than 80% of the premium dollars that they collect go toward medical care. For insurers covering large employers, the threshold is 85%.
The Department of Health and Human Services estimates that insurers will have to pay out over $1.1 billion in rebates to their policyholders. The average rebate will be $151. Included in the list of companies that will have to pay rebates are Aetna, Cigna, Humana and Unitedhealthcare.
Self-insured employers are exempt from the new rule, as are Medicare and Medicaid. Of the estimated 75 million people with healthcare plans, about 17% will get rebates.
In those cases where the coverage is through the employer, the rebates are being sent to them, and they can chose to put the rebate toward future premium costs instead of distributing them to the employees directly.
Insurers have the option of directly reducing future premiums instead of sending out rebate checks.
(7/26/12)- Beginning in 2014, the first penalties will be levied on individuals who have not purchased health insurance. The penalty is a flat amount or a percentage of an individual's income, whichever is greater, and it will phase in over 3 years.
For 2014, the dollar penalty is $95, rising to $695 in 2016. The 2014 income percentage is 1%, rising to 2.5% in 2016.
Individuals with employer-provided coverage meeting minimum standards will be exempt from the penalty, as will people covered by Medicare and Medicaid, and members of a religion opposed to accepting benefits.
(7/19/12)- Starting in 2013, there will be a 3.8% tax on net investment income for individual income tax taxpayers with adjusted gross income above $200,000 or $250,000 for joint filers.
The tax applies to gross income from interest, dividends, annuities, royalties and rents, and to net gains from investments. It might even apply to a large net gain on the sale of a home.
A 0.9% Medicare surtax will apply to most joint filers' wages and self-employment income above $200,000 for individual tax payers or above $250,000 for a joint income tax return.
The threshold for taxpayers claiming an itemized deduction for medical expenses rises to 10% from 7.5% of adjusted gross income. For taxpayers (and spouses) 65 or older the AGI threshold continues to be 7.5% until 2017. For those subject to the alternative minimum tax, the threshold remains 10% of AGI.
Contributions to flexible spending accounts (FSAs) are capped at $2,500 per employee, down from $5,000 or more per employee. The new cap is adjusted for inflation starting in 2013.
A medical-device excise tax of 2.3% of the sale price applies to certain products. It does not apply to eyeglasses, contact lenses and hearing aids, but does apply to pacemakers, stents and artificial hips. The House has repealed this provision but the Senate has not acted on it yet.
(7/4/12)- Upon further review here is the breakdown in the voting at the U.S. Supreme Court that upheld the constitutionality of the Patient Protection and Affordable Care Act of 2010.
The 5 to 4 majority opinion upholding its constitutionality was written by Chief Justice John Roberts. Justice Roberts wrote that the mandate requiring individuals to purchase health insurance fell within Congress' power to levy a tax. The other 4 justices who voted to uphold the "mandate" did so because of both the Congressional power to levy a tax and also because it fell under the provision of the commerce clause of the Constitution.
The four Justices who voted in favor of the law were Justice Sotomayer; Justice Ginsburg; Justice Kagan and Justice Breyer- the so-called liberal members of the court.
The four Justices who voted against the constitutionality of the law were Justice Kennedy; Justice Alito; Justice Scalia and Justice Thomas- the so-called conservatives of the court.
In connection with the Medicaid expansion under the law, the same 5 to 4 majority upheld the legality of the expansion, but held that the penalties for states that do not comply was unconstitutional.
The same 4 Justices who voted against the constitutionality of the law's "mandate" also rejected the Medicaid expansion entirely.
(7/2/12)- By a 5 to 4 vote, which was announced at 10 A.M on June 28th, the U.S. Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (PPACA) of March 23, 2010. Chief Justice John Roberts wrote the opinion for the decision in which the 4 liberal members of the court joined him.
The majority upheld the law based on Congress' power to levy taxes, rather than on the commerce clause of the Constitution. The Court did rule however in favor of the 26 largely Republican-led states, that the U.S. government could not expel states from Medicaid if they refused to go along with the expanded eligibility for the federal-state health program that is part of the new law.
Republican President George W. Bush had appointed Chief Justice Roberts to the court.
Starting in January 2014, most Americans will be required to have health insurance or be faced with a penalty for failure to do so. Taxpayers will be required to indicate on their tax returns whether they have health insurance that meets minimal benefits standards. If they fail to do so, they would owe $95, or 1 percent of taxable income, whichever is greater.
The penalty rises to $325, or 2 % of taxable income in 2015, and then $695, or 2.5% of taxable income in 2016, up to a maximum of $2,085 per family.
Beginning in 2014, the law expands Medicaid to cover people who are under 65 and earn income up to 133% of the federal poverty level, or $30,657 for a family of four in 2012. Families who make between 100% and 400% of the federal poverty level-or $92,200 for a family of four in 2012- will be eligible for tax credits for insurance plans that are purchased through state run exchanges.
Beginning in 2013, the law increases the Medicare tax by 0.9% on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly. It also imposes a 3.8% tax on unearned income for high-income households.
Firms with 50 or more workers will still have to pay a penalty that starts at $2,000 per full-time employee in 2014 if they don't provide insurance or their plan doesn't meet a standard.
The federal government will pick up the full cost for the expanded Medicaid provisions in the law, and thereafter it will pick up 90% of the expanded cost.
As noted in our item dated 6/27/12 below, people who fall in the "doughnut hole" will receive discounts on the cost of their drugs in "the hole" and the doughnut hole will be gradually phased out.
(6/27/12)- Under the terms of The Patient Protection and Affordable Care Act (PPACA) of March 23, 2010 the pharmaceutical industry agreed to give discounts to seniors who have drug expenses that exceed $2,930, but are less than $4,700. This is the famous "doughnut hole" that has caused so much confusion.
Once senior's drug expenses exceed $4,700, the patient is responsible for only 5% of the cost of the prescription drugs.
If the Supreme Court declares the law to be unconstitutional will the drug companies continue this discount program?
(6/9/12)- The House voted 270-146 to repeal a tax manufacturers of medical devices that was intended to pay for expanding coverage to uninsured individuals under the new Patient Protection Act of 2010.
37 Democrats joined with their Republican colleagues in favor of ending the tax. The measure would apply a 2.3% tax on the sales of most medical devices, and is scheduled to take effect in January.
The tax exempts goods such as contact lenses, hearing aids and eyeglasses.
(5/17/12)- The check from your health insurer will be coming in the mail is the refrain that we will be hearing a lot in the next few months. Under the terms of the Patient Protection and Affordable Care Act of 2010, health insurers that don't spend a specified amount of revenue on actual medical care for it policyholders must refund the difference to its customers.
The Kaiser Family Foundation estimates that the refunds will total about $1.3 billion and go to roughly 16 million people. These refunds will apply to employees whose coverage is through their employer or individually insured customers.
The checks will average $72 for those who get their insurance through their employer and $127 for those who bought individual policies, according to estimates from Kaiser.
Included in the envelope with the check will be a statement that begins: "This letter is to inform you that you will receive a rebate of a portion of your health insurance premiums. This rebate is required by the Affordable Care Act-the health reform law."
(3/25/12)- In connection with the issue of the constitutionality of the new health care law that will be argued before the Supreme Court is the issue of "the mandate". Exactly what is the mandate and what is the penalty for violating that issue?
"The mandate" is the requirement that all Americans have health insurance. The penalty for failure to have compulsory health insurance would start at $95 a year or 1% of income, whichever is higher, when the requirement takes effect in 2014.
(3/18/12)- The U.S. Supreme Court will hear oral arguments for 3 days on the constitutionality of the Patient Protection and Affordable Care Act of 2010 starting March 26th. The Court is expected to announce its decision some time in June. There will be no television coverage of the proceeding but the court will release oral tapes of the arguments on its Web site at 2 PM on Monday and Tuesday and at 4 PM on Wednesday
The law requires that 80% of the premiums that insurers collect from individuals be spent on health-care costs. If that threshold is not met, the insurance company will have to send rebates for the excess to its customers. The Department of Health and Human Services has set up a site at health-care.gov to see if a consumer is due a rebate check.
That site will also enable the consumer to determine which plan is best suited to his/her needs. It will list programs and resources available to the consumer on a state by state basis.
The site also reports on health plans that have requested premium increases and why. Starting in September, it plans to offer a summary of plan benefits and coverage for various scenarios.
If you are a senior who reaches the "doughnut hole" because of the cost of your prescription drugs, you will be entitled to a 50% discount on brand-name drugs and a 14% discount on generics.
Under the terms of the new health care law that was passed in 2010, the administration was supposed to establish medical payment reporting procedures by October 1, 2011. The public had until February 17 to comment on the proposals and the Department of Health and Human Services will then issues final rules with the force of law.
Analyses by the New York Times found that about a quarter of doctors take cash payments from drug or medical device manufacturers, and that nearly two-thirds accept gifts of food either for themselves or their staff.
The Obama administration has recently issued the standards required under the law. If a company has even only one product covered by Medicare or Medicaid, it will have to disclose all its payments to doctors, medical professionals, pharmaceutical companies and medical equipment companies other than its own employees. The federal government will post the data on a Web site where it will be available to the public.
The administration estimates that more than 1,100 drug, medical device and medical supply companies will have to file reports. Federal officials will inspect and audit the accuracy of the reports. Companies will be subject to a penalty of up to $10,000 for each payment they fail to report. A company that knowingly fails to report payments will be subject to a penalty of up to $100,000 for each violation, up to a total of $1 million a year.
A senior official of the company must attest to the accuracy of each report.
(1/18/12)- Kathleen Sebellius, the secretary of health and human services issued a finding against a health insurance company, Trustmark Life Insurance Company, a unit of Trustmark Mutual Holding Company, that its premium rate increase were unreasonable under federal standards. The finding means the company must either rescind the increase or justify its refusal to do so.
The Patient Protection and Affordable Care Act set detailed federal standards for an annual review of "unreasonable increases in premiums." Under rules issued by Ms. Sebelius, a rate increase of 10% or more must be reviewed and approved by either state or federal officials.
According to the latest statistics from the Department of Health and Human Services, premiums for health insurance totaled $849 billion in 2010, while spending on benefits totaled $746 billion in 2010. The difference includes administrative costs and profits.
This was the second time the provisions of the act has been used to deny a rate increase by a health insurance company. It was first used when Everence Insurance Company in Pennsylvania increased its premiums by an average of 12%.
Under the act, insurers must spend at least 80% of premium revenues on medical care and efforts to improve it. Gary Cohen, acting director of insurance oversight at the Department of Health and Human Services, said Trustmark did not meet this standard in any of the states that the premium rate increase applied to.
Almost 10,000 policyholders in Alabama, Arizona, Pennsylvania, Virginia and Wyoming will be affected by the ruling.
The federal government reviews the premium rate increases in states where it finds no adequate state agency to oversee the legality of the rate increase.
Ms. Sebillius praised Connecticut, New York and Oregon for forcing insurance companies to scale back recent rate increases.
(1/6/12)- Mary Brown, one of the plaintiffs who challenged the legality of the new health-care law based on the fact that her auto-repair shop in Florida could not afford to pay the premiums for her employees as required under the law, starting in 2014. That provision requires most Americans to carry health insurance of pay a penalty.
Two other plaintiffs were listed, i.e. a retired investment banker in the state of Washington, and the National Federation of Independent Business (NFIB), a small-business lobbying group based in Washington, D.C. Ms.Brown was the only plaintiff that the Justice Department had agreed had legal standing to pursue the case.
Ms.Brown closed her shop in August and has filed for personal bankruptcy. Thus her claim that the new law would hurt her business was no longer a valid argument in this matter.
The NFIB has filed a motion with the U.S. Supreme Court to add two members of its organization as plaintiffs. They are Dana Grimes, the owner of a roofing company in Greenwich, N.Y., and David Klemencic, who runs a flooring business in Ellenboro, W.Va. The Justice Department said that it would not oppose the motion
(12/24/11)- The Supreme Court announced that it would set aside 3 days to hear the challenges to the constitutionality of the Patient Protection and Affordable Care Act of 2010.
On March 26, the court will hear arguments on the threshold issues of whether challenges to the law are premature as the U.S. Court of Appeals for the 4th Circuit in Richmond, Va., ruled as we discussed in our item dated 9/17/11. In that ruling the majority cited a law known as the Anti-Injunction Act, which states that courts can't hear challenges to a tax until the tax goes into effect. Under the health care law, the levy for not having insurance does not commence until 2014.
On March 27, it will take up the issue of the legality of requiring people to buy health insurance by Congress under the Commerce clause of the Constitution.
On March 28, the court will hear arguments on whether the provision requiring insurance coverage may be severed from the rest of the law without declaring the rest of the law unconstitutional.
(12/21/11)- Under the terms of the Patient Protection and Affordable Care Act (PPACA) of March 23, 2010 most health insurance plans had to allow parents to start adding their adult children, up to the age of 26 to their own plan.
The percentage of those ages 19 to 25 with health insurance rose to 73% this past June from 64% in September 2010, when the provision went into effect, according to the latest survey of insurance coverage from the National Center for Health Statistics. That translated to about 21.5 million young adults, up from 19 million.
(12/15/11)- Obama administration officials announced that they would wind down a $5 billion fund to pay for health insurance for early retirees by December 31, instead of the September 2012 date that had been projected as late as October.
The fund was part of the new health-care law and was originally projected to last until 2014, when provisions in the new law will take effect making it easier for older Americans to buy health insurance without the help of an employer. The Centers for Medicare and Medicaid Services estimated that $4.5 billion of the fund had already been paid out.
(11/16/11)- In indicating how important the constitutionality issue is in connection with the appeal of The Patient Protection and Affordable Care Act (PPACA) of March 23, 2010 the U.S. Supreme Court scheduled five and a half hours of oral arguments instead of the usual one hour. The Supreme Court agreed to hear appeals from just one decision, that being the one from the U.S. Court of Appeals for the 11th Circuit in Atlanta as we discussed in our item dated 8/17/11 below.
The justices said they would consider the issue raised in the ruling from the matter before the U.S. Court of Appeals for the 4th Circuit in Richmond, Va., that we discussed in our item dated 9/17/11. In that ruling the majority cited a law known as the Anti-Injunction Act, which states that courts can't hear challenges to a tax until the tax goes into effect. Under the health care law, the levy for not having insurance does not commence until 2014.
Judge Brett M. Kavanaugh, in his 65-page opinion in connection with the ruling from the U.S. District Court of Appeals for the District of Columbia, that we discussed in our item dated 11/14/11, backed the viewpoint that the health care law could not be challenged until it was implemented in 2014. The Justice Department suggested that the Supreme Court appoint a lawyer in favor of this interpretation since it did not fully back this argument.
The justices will hear two hours of argument on whether Congress overstepped its constitutional authority, 90 minutes on whether the mandate for compulsory insurance may be severed from the balance of the law, and an hour each on the Medicaid and Anti-Injunction Act questions.
The Supreme Court agreed to hear three appeals, two from challengers to the law and a third from the Obama administration.
(11/15/11)- As we noted in our item dated 11/1/11, the justices of the U.S. Supreme Court voted to accept the matter as to the constitutionality of the The Patient Protection and Affordable Care Act (PPACA) of March 23, 2010. It is therefore expected that they will announce their decision in June of 2012 after holding a hearing on the case in March 2012.
(11/14/11)- The U.S. District Court of Appeals for the District of Columbia Circuit became the 3rd appellate court to rule in favor of the constitutionality of the new health care law, versus the one appellate court that has ruled against it.
In this latest decision, Judge Laurence Silberman, a leading conservative jurist, whose former law clerks played a key role in the George W. Bush administration, wrote the court's majority opinion. Republican ex-president Ronald Reagan appointed Judge Silberman to the court.
His 37-page opinion stated: "The right to be free from federal regulations is not absolute, and yields to the imperative that Congress be free to forge national solutions to national problems". Judge Brett M. Kavanaugh did not join in on Judge Silberman's written opinion, but voted to dismiss the appeal in his 65-page opinion, because the insurance requirement of the law could not be challenged until it was implemented in 2014.
Judge Kavanaugh's in his technically dissenting opinion position, supported the view of the majority in the decision dismissing the challenge to the law in the 4th Circuit that we discussed in our item dated 9/17/11 below. The Justice Department has indicated that it would not support this view when the Supreme Court takes up the case, saying it would hire outside counsel to argue this point.
Judge Kavanaugh cited the 19th-century Anti-Injunction Act, which he said "poses a jurisdictional bar to our deciding this case at this time."
For more information on this case, please see our item dated 3/9/11 below. Five individuals represented by the American Center for Law and Justice, a conservative Christian group, brought the action in the District of Columbia.
(11/1/11)- The justices of the U.S. Supreme Court are scheduled to discuss challenges to the new health care law during their private conference on November 10, according to the electronic docket entries recently posted on the court's Web site.
If the court agrees to consider the law, oral arguments would likely be scheduled for next spring, and a decision would be expected by the end of June. Two of the three appellate courts that have heard appeals in connection with the constitutionality of the law, have upheld it.
(10/28/11)- Department of Health and Human Services (HHS) Secretary, Kathleen Sebelius said in a letter to congressional leaders, that the department would not implement the long-term care portion of the new health care law. The program, known as the Class Act portion of the law was financially unsustainable.
HHS officials said that actuaries spent 19 months attempting to design a voluntary long-term care insurance program that met the requirements of the law, but were unable to come up with any fiscally viable plan.
(10/21/11)- Liberty University filed an appeal with the U.S. Supreme Court of the ruling on September 8th by the Richmond, Va. based Fourth U.S. Circuit Court of Appeal that dismissed its case which claimed that the "individual mandate" provision of the new health care law was a tax that could not be challenged until the provision went into effect in 2014.
For further information on this matter, please see our item dated 9/17/11 below.
Please also note that in our item dated 10/9/11 below, the U.S. Justice Department does not feel that this interpretation of the law is correct, and thus asked the Supreme Court to appoint an outside attorney to defend the decision in regards to the tax point.
(10/9/11)- The U.S. Justice Department had a deadline of September 26th to ask the U.S. Court of Appeals for the 11th Circuit in Atlanta to reconsider its decision that Congress could not require individuals to purchase health care insurance ("individual mandate"). For more information on that matter, please see our item dated 8/17/11 below
That federal appeals court found that Congress exceeded its powers to regulate commerce when it decided to require people to buy health insurance, under the provision in the law known as the "individual mandate". The court did however hold that while this provision was unconstitutional, the rest of the law could stand.
Most legal experts had expected the federal government to postpone taking the constitutionality issue of the new health care law to the Supreme Court, since the delaying tactic would mean that the law is constitutional until ruled otherwise.
The Justice Department could have postponed taking the case to the U.S. Supreme Court until November, but in a surprise development, it brought an appeal of the 11th Circuit court to be heard at its upcoming session. Oral argument on the case, if the Supreme Court decides to hear the case can begin in June 2012, with a decision expected before the election in November.
As we have noted in our items below, 2 appellate courts have upheld the law, while the 11th Circuit voted 2 to 1 against it. A fourth challenge to the law was heard recently by the U.S. Court of Appeals for the District of Columbia Circuit.
The 26 plaintiffs who had lost on the issue of constitutionality in the 11th Circuit have also petitioned the U.S. Supreme Court for a review of that part of the decision that rejected their claim. A second petition to hear the case to the Supreme Court was also filed by the National Federation of Independent Business and two individuals seeking to have the law declared unconstitutional.
A petition has also been filed before the Supreme Court from several individuals and the Thomas More Law Center seeking review of the decision of the 6th Circuit upholding the constitutionality of the law as we wrote about in our item dated 7/31/11 and 7/1/11 below.
The Justice Department also indicated that it did not feel that it could prevail in connection with the thinking of the court in the 4th Circuit about the "tax" not going into affect until 2014, so it requested that the Court appoint a lawyer to defend that position.
(9/26/11)- Officials in the Obama administration said that they may not enact a long-term-care insurance program that was set out in the Patient Protection and Affordable Care Act (PPACA) of March 23, 2010.
With budget deficits and cuts taking front and center in the news lately, officials at the Department of Health and Human Services said that they may not go forward with the program.
(9/17/11)- The U.S. Court of Appeals for the Fourth Circuit in Richmond Virginia dismissed two challenges to the new health care law. For more information on this matter, please see our item dated 5/17/11 below.
In a unanimous opinion, a three-judge panel found that Virginia Attorney General Ken Cuccinelli lacked legal standing to bring his challenge. Mr. Cuccinelli, a Republican had argued that the state of Virginia had passed a law saying that the state's residents could not be required to carry health insurance. He also argued that the Commerce Clause of the Constitution prevented the federal government from imposing such a burden on the state's residents.
The three judges on the panel had all been appointed by Democratic presidents. Judge Diana Gribbon Motz wrote the opinion, as well as another opinion, in which the judges voted 2 to 1 to dismiss a case brought by Liberty University of Lynchburg, Va., on a different set of technical grounds.
The majority cited a law known as the Anti-Injunction Act, which states that courts can't hear challenges to a tax until the tax goes into effect. Under the health care law, the levy for not having insurance does not commence until 2014.
(8/17/11)- The U.S. Court of Appeals for the 11th Circuit in Atlanta, in a 2 to 1 vote, ruled that the provision requiring Americans to buy health insurance or face tax penalties was not unconstitutional.
The court found that Congress exceeded its powers to regulate commerce when it decided to require people to buy health insurance, under the provision in the law known as the "individual mandate". The court did however hold that while this provision was unconstitutional, the rest of the law could stand.
Thus the scoreboard now stands one appellate court upholding the constitutionality of the law, while another appellate court denied the constitutionality of the provision requiring individuals to purchase health insurance by the year 2014, or face tax penalties.
For more on the ruling of the U.S. Court of Appeals for the Sixth Circuit in Cincinnati which upheld the constitutionality of the law, please see our item dated 7/1/11 below.
The majority opinion for the 11th Circuit's ruling was written by Chief Judge Joel F.Dubina, who was appointed by the first George Bush, and Judge Frank M.Hull, who was named by President Bill Clinton. Judge Stanley Marcus, another Clinton appointee, wrote the dissenting opinion.
(7/31/11)- Slowly but surely the constitutionality of the health care law of 2010 is wending its way through the legal system as it heads to the Supreme Court. In the most recent development, a petition was submitted to the Supreme Court appealing the ruling of the U.S. Court of Appeals for the Sixth Circuit in Cincinnati upholding the constitutionality of the law as we discussed in our item dated 7/1/11 below.
In that ruling, Judge Jeffrey S. Sutton, who had served as a law clerk to Justice Antonin Scalia, and who had been appointed to the bench by a Republican president, George W. Bush, voted in favor of the constitutionality of the law.
(7/29/11)- Federal administrators will soon take over the review of health insurance premium rates in 10 states where it says state officials do not adequately regulate premiums for insurance sold to individuals or small businesses.
Starting September 1, federal and state officials will begin to scrutinize proposed rate increases of more than 10% to determine if they are justified.
Obama officials state that in publicizing excessive, unreasonable health insurance premium rate increases, they are protecting consumers under the new health care act.
Seven states- Alabama, Arizona, Idaho, Louisiana, Missouri, Montana and Wyoming-do not have effective rate review programs for either individuals or small-health-group insurance premium increases.
In three other states- Iowa, Pennsylvania and Virginia- the federal government will review proposed premium increases for small groups and will allow states to review individual rates.
(7/1/11)- The U.S. Court of Appeals for the Sixth Circuit in Cincinnati has upheld the constitutionality of the Patient Protection and Affordable Care Act of 2010. The ruling came in a 2-1 vote, with one of the judges who was appointed by a Republican president joining to form the majority with a judge appointed by a Democrat.
Opinions are expected shortly from panels in the Fourth Circuit in Richmond, Va., and the 11th Circuit in Atlanta. The majority consisted of Judge Jeffrey S. Sutton, an appointee of President George W. Bush, a Republican and Judge Boyce F. Martin Jr., a Democrat appointed by President Jimmy Carter. The dissenting jurist was Judge James L. Graham, a Republican appointed by President Ronald Reagan.
The appeal had been filed by the Thomas More Law Center, a conservative public interest firm in Ann Arbor, Mich., from the decision rendered by Judge George C. Steeh in the Federal District Court in Michigan. For more on this case please see our item dated 6/3/11 below.
(6/27/11)- Obama administration officials announced that they would postpone until January 1, 2012 the requirement, contained in the 2010 health care act, that insurance companies offer an explanation when they refuse to pay a claim and grant consumers an internal and external review of the denial.
States are expected to handle the review, and if they don't, the federal government will step in to do so.
(6/16/11)- It is only a matter of time before the U.S. Supreme Court will decide upon the new health care law's constitutionality. It will fall on the solicitor general to defend the law's legality, and so the appointment and confirmation in the Senate by a vote of 72 to 16 of Donald Verrilli Jr. is going to have huge ramifications at the trial.
The post has been vacant since Elena Kagan left it to become a member of the Supreme Court last August. Mr. Verrilli has been the deputy counsel to President Obama. Before that, he was an associate deputy attorney general. He clerked for former Justice William J. Brenner Jr.
(6/10/11)- Blue Shield of California, one of the largest health insurers in the nation said it would refund $167 million to policyholders as part of its plan to limit its profits to no more than 2% of its revenue. The company also went on to announce that it had already planned to return $180 million, the profit the company said it made above the 2010 target.
On average, this means that the typical policyholder would receive a 30% credit towards one month's premiums. Hospitals and doctors that participate in programs aimed at better coordinating care for patients would receive $10 million, California lawmakers are considering legislation that would give state regulators the authority to approve insurers' rate increase requests before they go into effect. Please also see our item dated 5/25/11 below.
(6/3/11)- A three-judge panel of the Sixth U.S.Circuit Court of Appeals heard 90 minutes of oral arguments in the matter of the constitutionality of the new health care law. A Republican president appointed two of the 3 judges on the panel, while a Democratic president appointed the 3rd member of the panel.
Judge Jeffrey S. Sutton was appointed by ex-president George W. Bush, while ex-president Ronald Reagan appointed District Court Judge James L. Graham of Ohio, who is temporarily assigned to the appellate bench. The Democratic appointment on the panel is Royce F. Martin Jr. who was appointed by ex- President Jimmy Carter.
Neal K. Katyal, the acting United States solicitor general defended the constitutionality of the law for the federal government. The challenge to the law had been filed by the Thomas More Law Center, a public interest law firm in Ann Arbor, Michigan. Robert J. Muise argued the case for the Law Center.
A hearing on the constitutionality of the health care law will be held before the 11th Circuit in Atlanta next week.
(5/25/11)- Under the terms of the new health care law, federal and state officials will review health insurance premium increases in the individual and small group insurance market to insure that any increases are not excessive.
Federal officials do not have the authority to block rate increases, even if they find them to be excessive, but many state authorities do have the power to block the increase.
Kathleen Sebelius, the secretary of health and human services issued a final rule that established procedures for federal and state insurance experts to scrutinize the increases. Federal officials had proposed a 10% maximum increase in December, and that figure was finalized under the new rulings.
"Health insurance companies have recently reported some of their highest profits in years and are holding record reserves, " Ms Sebelius said. "Insurers are seeing lower medical costs, as people put off care and treatment in a recovering economy. But many insurance companies continue to raise their rates. Often, these increases come without any explanation or justification."
Starting in September 2012, the federal government will set a separate threshold for each state, reflecting trends in insurance and health care costs in that state. Under the terms of the new health care law, the federal government will provide the states with the financing to strengthen their capacity to oversee the rate increase in their state.
The new rule states that a rate increase is unreasonable if it is excessive, unjustified or " unfairly discriminatory." An increase is deemed excessive if it is "unreasonably high in relation to the benefits provided."
(5/17/11)- Since the enactment of The Patient Protection and Affordable Care Act (PPACA), 31 lawsuits have been filed to challenge it, according to the Justice Department. Nine are awaiting action by Courts of Appeals, and nine are pending in federal district courts. The others have been dismissed.
The United States Court of Appeals for the Fourth Circuit is presently holding hearings on 2 lower court contradictory decisions from within its jurisdiction. On June 1, the Court of Appeals for the Sixth Circuit in Cincinnati will hear the appeal of a ruling in favor of the law. On June 8, the Court of Appeals for the 11th Circuit in Atlanta will review a Florida judge's ruling that held the law to be unconstitutional.
Neal K. Katyal, the acting solicitor general, will represent the Obama administration in each of the appellate cases.
(4/28/11)- The U.S. Supreme Court turned down a petition for expedited review from Virginia of the state's challenge to the new health care law. There were no noted dissenting votes, nor was any reason given for the refusal.
3 federal district courts have upheld the constitutionality of the law and 2 have declared the law to be unconstitutional. The case questioning the constitutionality of the law is now expected to reach the Supreme Court in the term that starts in October.
The first of the appeals will be heard starting with oral arguments in the United States Court of Appeals for the Fourth Circuit, in Richmond, Virginia in Virginia's challenge and a companion case on May 10.
Virginia's Attorney General Kenneth T. Cuccinelli II filed for the expedited review before the U.S. Supreme Court in February, citing the large expense that the state was undergoing in carrying out the terms of the law. The filing also stated that in all likelihood the matter would have to be decided by the Supreme Court in light of the conflicting decisions.
Acting Solicitor General Neal K. Katyal represented the federal government in opposing the expedited hearing petition in the case, Virginia v.Sebelius, No.10-1014. Supreme Court Justice Elena Kagan, who joined the Supreme Court in August, after serving a year as the United States solicitor general did not recuse herself in turning down the petition, leading legal experts to conclude that she will not recuse herself from hearing the case when it comes before them during the regular fall session of the court.
(4/20/11)- Missouri's Democratic attorney general filed a "friend of the court" brief in the United States Court of Appeals for the 11th Circuit, in Atlanta, in support of the attorneys general from 26 states opposing the constitutionality of the new health care law.
The filing of the brief by Attorney General Chris Koster, a onetime Republican state legislator who switched to the Democratic party in 2i007 did not mean that he was joining with the other 26 states as a plaintiff in the action.
The only Democratic state attorney general who is a plaintiff in the action is Attorney General Buddy Carswell of Louisiana, who switched to the Republican party in February.
Three lower court judges have upheld the constitutionality of the law, while two have declared the law to be unconstitutional.
(3/15/11)- The Justice Department filed a notice of appeal of the decision by Judge Roger Vinson of the U.S. District Court for the Northern District of Florida, who declared that the new health care law was unconstitutional. The Justice Department said it was asking the Court of Appeals for the 11th circuit in Atlanta to provide an "expedited review" of the decision.
(3/9/11)- Judge Roger Vinson of the U.S. District Court for the Northern District of Florida granted a stay to his January ruling (please see our item dated 2/1/11 below) provided that the Justice Department files an appeal of his decision within 7 days of this ruling.
Tracy Schmaler, a spokesman for the Justice Department said a request for an expedited appeal would be "promptly" filed with the Court of Appeals for the 11th circuit in Atlanta.
The United States Court of Appeals for the Sixth Circuit, in Cincinnati and the United States Court of Appeals for the Fourth Circuit, in Richmond, Va. will be hearing appeals in connection with the constitutionality of the new health care law within the next few months.
It is clear that ultimately the U.S. Supreme Court, sometimes within the next year to year and a half, will be the arbitrator-of-last-resort in this matter.
(3/4/11)- Let the scoreboard now read 3 to 2 in favor of upholding the constitutionality of the new health care law. U.S. District Court Judge Gladys Kessler in Washington, D.C. became the third judge ruling in favor of the constitutionality of the law. It is no coincidence that the judges who have ruled in favor of the constitutionality of the law were all appointed by Democratic presidents, while those how have ruled that the law is unconstitutional have been appointed by Republican presidents.
According to Judge Kessler, who was appointed to her position by former President Bill Clinton, "Congress had a rational basis for its conclusion that the aggregate of individual decisions not to purchase health insurance substantially affects the national health insurance market."
She went on to say that those who do not purchase insurance " will ultimately get a 'free ride' on the backs of those Americans who have made responsible choices to provide for the illness we all must face at some point in our lives."
Five individuals represented by the American Center for Law and Justice, a conservative Christian group filed the District of Columbia case.
In her 64-page opinion Judge Kessler also tossed out a claim that the law restricted the plaintiffs' exercise of religious freedom because the mandate to buy health insurance conflicted with their belief that G'd would provide for their well being.
(2/22/11)- As noted in our item dated 2/1/11 below, Judge Roger Vinson of the U.S. District Court for the Northern District of Florida ruled that the Patient Protection and Affordable Care Act of March 23, 2010 was unconstitutional, since its provisions violated the commerce clause of the Constitution.
While the judge did not specifically enjoin the act from being enforced, he used the language that his ruling should be treated as the "functional equivalent" of an injunction.
The U.S. Justice Department has asked the judge to clarify his decision in regards to the governments ability to continue to implement the terms of the law while the ruling was being appealed.
Judge Vinson's decision is in the process of being appealed to the United States Court of Appeals for the 11th Circuit. The government's filing indicates those provisions of the law that it feels have already taken effect,, such as tax credits for small business, increased Medicare payments to providers, antifraud measures, high-risk insurance pools and grants to the states, and asks if his ruling intends for each to be suspended.
(2/18/11)- The United States Court of Appeals for the Sixth Circuit, in Cincinnati, announced that it would hear oral arguments during a term that stretches from May 30 to June 10th of the decision of Judge George C. Steeh of the Federal District Court in Detroit, Michigan that upheld the constitutionality of the health care law. For additional information on this case please see our item dated 10/15/10 below.
The United States Court of Appeals for the Fourth Circuit, in Richmond, Va., had already announced that it will hear arguments in mid-May in the Obama administration's appeal of the decision by Judge Henry E. Hudson of the U.S. District Court in Richmond, Va. declaring a central provision of the law unconstitutional.
More than 70 House Democrats in Washington have come out stating that Justice Clarence Thomas should recuse himself when the case reaches the Supreme Court, since his wife has been a paid lobbyist for conservative groups opposed to the law.
(2/11/11)- Even though the Court of Appeals for the Fourth Circuit in Richmond, Virginia has agreed to hear the appeal by the Justice Department of the decision by Judge Henry E. Hudson of the U.S. District Court in Richmond, Va. that struck down the constitutionality of the Patient Protection and Affordable Care Act of 2010 (PPACA), Kenneth T. Cuccinelli II, the attorney general of Virginia said that he would seek an expedited review of the case by the U.S. Supreme Court. Please see our item dated 1/29/11 and 12/17/10 below.
As we have noted in this article, two federal courts have upheld the constitutionality of the law, while 2 other federal courts have declared the act to be unconstitutional.
It is quite rare for the Supreme Court to hear a case speedily under the expedited review process.
The Obama administration will oppose the expedited review, since the provisions of the law remain in effect, unless enjoined from doing so by a lower court, Thus the provisions of the act are constitutional unless the U.S.Supreme Court rules otherwise.
In November 2010, the Supreme Court refused to review another challenge to the act that had been dismissed by a California judge on the groungs that the plaintiffs did not have standing to sue.
(2/1/11)- Judge Roger Vinson of the U.S. District Court for the Northern District of Florida ruled that the Patient Protection and Affordable Care Act of March 23, 2010 was unconstitutional, since its provisions violated the commerce clause of the Constitution. For more background information on this case please see our items dated 10/19/10 and1/21/10 below.
The suit questioning the constitutionality of the law was brought by former Florida Republican Attorney General Bill McCollum, who was joined, as plaintiffs, by the nation's most influential small business lobby. Ultimately 26 states joined the suit as plaintiffs, 25 of who were from Republican states.
In addition to Florida the states joining the action as plaintiffs were: Alabama, Alaska, Arizona, Colorado, Georgia, Indiana, Idaho, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming.
Although Judge Vinson did declare the law unconstitutional, he did not issue an injunction against the provisions of the act from being carried out.
Thus we now have 2 federal judges who were Democrats ruling in favor of the constitutionality of the law and 2 Republican federal judges ruling against its constitutionality.
The Justice Department announced that it would appeal Judge Vinson 78 page decision. Judge Vinson ruled that it was unconstitutional for the federal government to require American to buy health care insurance or else face being fined by the IRS in 2014, when that provision is due to go into effect.
It is inevitable that the ultimate determination of the constitutionality of the law will be decided by the U. S. Supreme Court within the next 1 year to 1 1/2 years.
(1/29/11)- The Court of Appeals for the Fourth Circuit in Richmond, Virginia announced that it would expedite its consideration of the lower court ruling that held the Patient Protection and Affordable Care Act of 2010 (PPACA) unconstitutional. Please see our item dated 12/17/10 below.
The appellate court will hear oral arguments between May 10 and May 13 on the Justice Department's appeal to overturn the ruling of Judge Henry E. Hudson of the U.S. District Court in Richmond.
Judge Hudson had ruled that Congress had exceeded the boundaries of the Commerce Clause of the Constitution by requiring Americans to obtain commercial health insurance. Judge Hudson did allow the law to remain in effect while the appeal is pending.
(1/21/11)- Six more states have joined the lawsuit questioning the constitutionality of the Patient Protection and Affordable Care Act that is now pending before Judge Roger Vinson of the U.S. District Court for the Northern District of Florida. For additional details on this lawsuit please see our item dated 10/19/10 below.
The six from Iowa, Kansas, Maine, Ohio, Wisconsin and Wyoming all have Republican attorneys general. Thus, of the 26 states involved in this legal action attacking the constitutionality of the law, 25 are from states with Republican attorneys general.
The U.S. House of Representatives voted 245 to 189 to repeal the act. Three Democratic senators voted along with 242 Republicans in favor of repealing the act.
Democratic Senate leaders who control the Senate said that they will not act on the repeal measure.
(1/19/11)- Beginning in July of this year, the Patient Protection and Affordable Care Act (PPACA) of March 23, 2010 gives federal regulators the right to review health premium increases by insurance companies greater than 10%, if a state does not have sufficient procedures of its own in this area.
David Jones, the recently appointed health commissioner of California raised questions about the premium increases assessed by some of the health care insurance companies in that state. On January 6, he called on Blue Shield of California to delay premium increases of up to 59%.
He also called on Aetna Inc. and units of WellPoint Inc and UnitedHealth Group Inc. to postpone their price increases as he reviews them
California is the biggest market for insurance purchased by individuals, accounting for 15% of the national figure. About 2 million Californians bought individual policies in 2009, more than double the number in Texas (907,717), the state with the second largest individual market, according to the Kaiser Family Foundation.
Florida had 893,765 single health-care policies purchased by its residents and New York had 740,539 single purchaser policies.
The California insurance commissioner does not have the power to reject the increases, but he can review the applications for rate increases and ensure that they are in compliance with the state law.
Last year, WellPoint sought a 39% increase in California, which was eventually decreased to a 14% increase.
Federal regulators would also not be able to reject increases, but the hope is that by publicly requiring the insurance companies to justify the increases, the insurance companies will be held accountable by the public.
(1/4/11)- The first major beneficiaries of the new Patient Protection and Affordable Care Act of 2010 will be those Medicare Part D plan members who fall into the "doughnut hole". Enrollees whose total drug costs for the year fall between $2,840 and $6,448 will get a 50% discount of branded prescription drugs and 7% discount on generic drugs.
Those who fell into the hole in 2010 received a $250 rebate in 2010 to offset the cost of paying for those drugs out-of-pocket.
Medicare beneficiaries with annual incomes above $85,000 for individuals and $170,000 for couples will get a smaller subside for Medicare Part D prescriptions.
The pharmaceutical industry will face a $2.5 billion levy in that their profit margins will be reduced by the lower prices for drugs falling into the "doughnut hole".
About 20 preventive health services, including colorectal cancer screenings, mammograms and smoking cessation services will be free for Medicare beneficiaries.
(12/29/10)- The $250 billion stop-gap funding measure that was recently passed by Congress does not contain the needed financing for the Patient Protection and Affordable Care Act of 2010. The Internal Revenue Service needs additional funding to enforce the requirement that most Americans carry health insurance by 2014.
Republicans are also looking to cut funds for the law's expansion of the Medicaid insurance program for the poor, and for subsidies to offset the cost to buying insurance for lower income individuals and families. There would not be financing for the new board that will recommend Medicare spending reductions, and for parts of the law tied to abortion coverage services.
The Department of Health and Human Services has the power to redirect money from other operations to cover some of the gaps in the new law, but a battle certainly will develop over these matters when the new Congress comes into session.
(12/17/10)- The Justice Department announced that it would appeal the decision of Judge Henry E. Hudson of the U.S. District Court in Richmond, Va.,that declared the Patient Protection and Affordable Care Act of 2010 (PPACA ) unconstitutional, . The Richmond case was filed by Virginia's attorney general, Kenneth T. Cuccinelli II, a Republican, and all but one of the 20 attorneys general and governors who filed a similar case before Judge Roger Vinson in Pensacola, Fla, are Republicans.
The two previous rulings that upheld the constitutionality of the act are already before the midlevel courts of appeal, with the Detroit case in the Sixth Circuit in Cincinnati., and the Lynchburg case in the Fourth Circuit in Richmond, which is the same circuit court where Judge Hudson decision will be appealed. Lynchburg is only 116 miles from Richmond, even though the decisions are on opposite sides of the issue.
(12/14/10)- Federal Judge Henry E. Hudson in Richmond, Virgina, as expected, ruled against the constitutionality of the Health-Care Reform Act of 2010. Thus he became the first federal jurist to rule against the constitutionality of the law, as opposed to the two prior rulings that had upheld the law as constitutional.
For more information on these cases please see our items directly below this one.
The next judge to rule on this issue will be Judge Roger Vinson of the U.S. District Court for the Northern District of Florida. Please see our item dated 10/19/10 below.
Judge Hudson based his ruling on the fact that Congress had exceeded its constitutional power to regulate commerce by penalizing individuals who, by their "inaction", failed to obtain health insurance as required by the law. In his opinion, "inaction" is not covered by the commerce clause of the Constitution.
There is no doubt that whichever side wins in these cases, it will be the U.S. Supreme Court that will have the final say on the matter.
(12/7/10)- A second federal court judge has upheld the constitutionality of the new health-care law in dismissing a lawsuit brought by Liberty University in Lynchburg, Virginia. In doing so, the judge, Norman K. Moon upheld the law as being within the constitutional power of Congress to regulate interstate commerce.
Judge George C. Steeh of the Federal District Court in Detroit had also upheld the constitutionality of the law as noted in our item dated 10/15/10 below. President Bill Clinton had appointed both Judge Steeh and Judge Moon.
Two other federal court judges are expected to rule on the constitutionality of the law within the next two months. For more details on the case pending before Judge Roger Vinson, of the U.S. District Court for the Northern District of Florida please see our item dated 10/19/10 below.
The other judge who is expected to rule on the constitutionality of the law is Judge Henry E. Hudson in Richmond, Virgina. Republican presidents appointed Judge Vinson and Judge Hudson.
The item in the law causing most of the lawsuits is the requirement for individuals to buy health insurance by 2014. Even though the law provides for subsidies to be paid for the poor in getting the insurance, opponents of the law argue that this violates the Interstate Commerce clause of the Constitution..
In effect opponents of the law argue that this requirement would amount to the regulation of inactivity. Judge Moon disagreed with this argument when he stated: "Far from 'inactivity', by choosing to forgo insurance, plaintiffs are making an economic decision t try to pay for health care services later, out of pocket, rather than now, through the purchase of insurance."
(10/27/10)-Slowly but surely the cases arguing against the constitutionality of the Health-Care Reform Act of March 2010 are wending their way through the court system. In the latest case, where a hearing was held before U.S. District Judge Henry E. Hudson that took up almost 3 hours, the judge announced that he would announce his decision before the end of the year.
As our item dated 10/15/10 below reports, Judge George C. Steeh of the U.S. District Court in Michigan, whom Bill Clinton appointed upheld the constitutionality of the law. On the other hand Judge Roger Vinson of the U.S. District Court for the Northern District of Florida seemed to indicate that he doubted the constitutionality of the law. Please see our item dated 10/19/10 below.
Republican presidents appointed both Judges Hudson and Vinson.
It seems quite clear that at this point that no matter which side prevails in the lower court decisions, ultimately the Supreme Court will have to decide on the constitutionality of the law.
(10/19/10)- A federal court judge in Florida denied a government motion to dismiss an action brought by 18 Republican attorneys general, 2 Democratic attorneys general, two individuals and the National Federation of Independent Business (which represents small businesses) that questioned the constitutionality of the Health-Care Reform Act of 2010.
The judge, Roger Vinson of the U.S. District Court for the Northern District of Florida who will now proceed to hear the case went, on to say: "at this stage of the case, the plaintiffs have most definitely stated a plausible case." The case will now proceed to a full hearing on December 16th.
The plaintiffs also argued that the law's provision expanding Medicaid to 16 million Americans was unconstitutional because it would impose costs that the states could not afford.
Please see our item dated 10/15/10 below, where a federal judge in Michigan upheld the constitutionality of the law.
(10/15/10)- Judge George C. Steeh of the Federal District Court in Detroit, Michigan became the first jurist to rule on the constitutionality of the new health care law. The judge upheld the constitutionality of the law, stating: the provisions of the new law cover "activities that substantially affect interstate commerce".
The central question is whether the Commerce Clause of the Constitution gives Congress the authority to require citizens to obtain a commercial health insurance contract by 2014, when that provision goes into affect. There are about 20 other state lawsuits questioning the Constitutional legality of the provision, with the next hearing being held on October 18th in Virginia.
Judge Steen was appointed by President Bill Clinton who went on to say: "These decisions, viewed in the aggregate have clear and direct impacts on health care providers, taxpayers and the insured population who ultimately pay for the care provided to those who go without insurance."
(10/10/10)-Under present Medicare Part D coverage, seniors pay a $310 deductible, then 25% of their drug costs until they reach $2,830 in total prescription drug expenses for the year. After that, beneficiaries must pay for drugs out-of-pocket until expenses exceed $6,440. This is the so-called " doughnut hole". After reaching that expense level a beneficiary pays 5% of the drug costs for the rest of the year.
Under the new health-care reform bill beneficiaries will receive a 50% discount on brand-name drugs, and a 7% discount on generics when they reach the "doughnut hole" level. By the year 2020 the " doughnut hole" will be entirely eliminated.
Under the new health care law, most government subsidies that Medicare Advantage plans have received will be phased out by 2017. In 2011, the subsidies will be frozen at last year's level.
In 2011, open enrollment for Medicare Advantage plans will be from January 1 through February 15, instead of its present timeframe of January 1 through March 31. Under the old system Medicare Advantage plan participants could change insurers or go back to regular Medicare. Under the new law, a beneficiary will be allowed to only go from Medicare Advantage plans back to regular Medicare. You will not be allowed to switch from regular Medicare to Medicare Advantage.
(9/20/10)- The number of Americans without health insurance rose by 4.4 million to 50.7 million last year, the largest annual jump since the government began collecting comparable data in 1987, according to figures from the U.S. Census Bureau.
The percentage of Americans covered by private insurance in 2009, 63.9%, was the lowest since 1987,while the percentage of people covered by government programs, 30.6%, was the highest. The number of American with some form of health insurance dropped last year for the first time since 1987 to 253.6 million in 209 from 255.1 million in 2008.
The 50.7 million Americans who are uninsured is 16.7% of the population. The number of Americans with employer-sponsored coverage dropped by 6.6 million to 169.7 million last year from 176.3 million in 2008- the largest one time drop since 1987.
The total number of Americans with private insurance fell to 194.5 million from 201 million. The number of Americans covered by Medicaid increased to 47.8 million in 2009 from 42.6 million in 2008, and is now the largest percentage of the population on the program since 1987.
(8/6/10)- U.S. District Judge Henry Hudson denied a motion by the U.S. Justice Department to dismiss the case brought by the Commonwealth of Virginia's Attorney General Ken Cuccinelli to declare the Health Reform Act of 2010 unconstitutional
The suit argued that the federal government does not have the authority under the Constitution's Commerce Clause nor the taxing power to require citizens to buy health insurance or pay a penalty. There are 21 states currently contesting the constitutionality of the Health-Care Reform Act of 2010
A further hearing on the matter will be held on October 18th.
The Virginia Health Care Freedom Act passed this year, declared that residents of the state cannot be forced to buy health insurance. The federal health-care legislation requires most U.S. residents to have health-care coverage or pay a penalty by 2014.
(7/29/10)- President Barack Obama's heath-care reform act that passed in 2010 allows the FDA to approve generic biologics to be marketed, with the FDA setting the rules as to how that approval can be granted
The FDA recently approved the first generic version of the blood thinner Lovenox (enoxaparin) to be sold in this country. Lovenox, is manufactured and sold by Sanofi-Aventis SA, while the generic version thereof will be marketed by a subsidiary of Novartis AG.
Sanofi's subsidiary, Momenta indicated it may bring legal action to prevent the generic version of Lovenox to be marketed because the drug is too complex to be copied safely. Lovenox is drawn from animal proteins, and is in the middle of the categorization of a traditional chemical drug and a biologic drug made from human proteins.
(7/17/10)- The Obama administration released the rules specifying which preventive services insurers must provide to consumers at no additional cost for new health plans that begin coverage after September 23, 2010, and to health plans that make significant changes after that date. The rules stipulate that no co-payments can be charged for the tests and screenings.
The administration does concede that as a result of these rules, premiums will be increased by about 1.5% on average. The rules arose as required under the new Health-Care Reform Act of 2010.
The rules will eliminate co-payments, deductibles and other charges for blood pressure, diabetes and cholesterol tests; many cancer screenings; routine vaccinations/ prenatal care' and regular wellness visits for infants and children.
Counseling to help people stop smoking, screening and counseling for obesity; and test for infection with virus that causes AIDS must also be offered at no cost.
The administration is working on a supplemental list of free preventive services for women.
(7/11/10)- The new health-care reform law requires pharmaceutical companies and medical equipment manufacturers to report physician-payment data to the government, which the U.S. Department of Health and Human Services will consolidate and make available on a public Web site. This requirement for annual reporting is to begin in 2013.
(6/29/10)- There are about 1400 American corporations that have been receiving federal tax subsidies since 2003 to offset their costs for prescription drugs for their retirees who are covered under their health-care and benefits plans. This subsidy, which amounts to about $600 per eligible retiree was granted so that the corporations would continue to cover retirees' drug benefit costs, and not shift them onto Medicare.
Under the new health care legislation that was recently enacted, this subsidy will end, and not be available again until 2013.
Navistar International Corp. announced that it would drop prescription drug benefits for its approximately 38,600 retirees and their spouses, of whom, about 22,000 are 65 or older, thus in effect causing eligible retirees and spouses to apply for Part D coverage for their pharmaceutical needs..
The United AutoWorkers (UAW) union has petitioned the federal district court in Dayton, Ohio, to block this change.
(6/11/10)- The government will begin to mail $250 checks to seniors today, who belong to Medicare and fell into the so-called "doughnut hole". The "doughnut hole" is when prescription drug spending totaled between $2,831 to $6,440 in 2009, and thus no insurance coverage reimbursed them for any part of that expenditure.
In reality this means that about one in 10 individuals who are on Medicare will receive the check, or about 4 million people.
The bill cuts about $455 billion in Medicare spending over a decade from payments to hospitals and other health-care providers. About $136 billion of this cut will hit Medicare Advantage plans.
(6/6/10)- The new health-care reform act requires pharmaceutical companies to advise Congress as to how many free samples of their products they distribute.
Pfizer Inc. gave out 101 million drug samples worth $2.7 billion in 2007. Merck & Co. gave out 39 million samples worth $356 million and Eli Lilly & Co. gave out 33million samples worth $67 million.
The value of the drugs reported to Congress was based on either the market price or the wholesale cost for the drugs.
In addition to the free samples, Pfizer said it has helped six million patients receive more than 48 million Pfizer prescriptions, which was worth an estimated $5.7 billion as part of its program to help low income individuals receive low to no-cost drugs.
(5/29/10)- Kathleen Sebelius, the secretary of health and human resources announced that the federal government would soon begin sending $250 checks to Medicare beneficiaries who had prescription drug costs that hit the " doughnut hole" in 2009.
The first checks will go out June 10, and the government estimates that about 4 million Medicare beneficiaries will receive these checks by the end of the year. The government will automatically send out the checks and Medicare beneficiaries do not have to fill out any forms to get the checks.
(5/13/10)- According to the latest estimate from the Congressional Budget Office, the new-health care law could add at least $115 billion more to government health-care spending over the next 10 years.
The new estimate includes an additional $10 billion to $20 billion in administrative costs to the federal agencies carrying out the law, $34 billion for community health centers and $39 billion for Indian health care.
If Congress approves all the additional spending called for in the legislation, it would push the 10-year cost of the health-care reform above the $1 trillion mark that the Obama administration had set as the ceiling.
(5/10/10)- Under a temporary $5 billion program, that was a part of the Health-Care Reform Act of 2010, the federal government will reimburse employers for 80% of the cost of claims from between $15,000 to $90,000 a year for a retired worker who is 50 or older and not eligible for Medicare.
The program will run from June 1, 2010 to January 1, 2014, when many early retirees will be able to enroll in health plans offered through new state-based markets known as insurance exchanges.
The aim of this program is to help induce employers to keep health-care coverage for early retirees who are not eligible for Medicare, but earn too much, or have too much in assets to be eligible for Medicaid.
Kathleen Sebelius, the secretary of health and human services, predicted that 4,500 employers and early retirees would seek federal help under the program. The government could deny or stop accepting applications for the program if it appeared that the $5 billion would run out before 2014.
(4/12/10)- The parts of the new health-care reform legislation governing preventive care go into effect on September 23rd, 2010, which is six months after it was signed by the president. If Medicare covers you, the upgrades to preventive care go into effect January 1, 2011.
On September 23rd new health-care insurance plans, and plans that make changes, must start to offer free preventive care.
The preventive services will include those that the United Stated Preventive Services Task Force (USPSTF) has given their top A or B rating, like screening for HIV, depression, osteoporosis in postmenopausal women, as well as breast, colorectal and cervical cancer. The USPTF is a panel of outside medical experts under the Health and Human Services Department.
Children will receive free screenings for conditions including iron deficiency, sickle cell diseases and hypothyrodiism.
Immunizations recommended by the Centers for Disease Control and Prevention (CDC) will be covered, including vaccines for Hepatitis A & B, tetanus-diphtheria, seasonal flu vaccines and human papilloma virus for girls 9 to 26 years old.
(3/29/10)- When prescription drug coverage was extended to Medicare beneficiaries in 2003 as Medicare Part D, it was feared that many corporations would abandon drug coverage for their retirees, and thus force the retirees into Part D coverage.
To encourage corporate America to continue to offer prescription drug coverage for their retirees, beginning in 2006, companies have received a 28% federal subsidy, or up to $1,330 per retiree, tax-free.
In addition to receiving the subsidy, the company could deduct it from their taxes. Under the new law, companies will no longer be able to deduct the subsidy, but it remains tax-free. The change does not take effect under the new health-care reform law until 2013, but they have to take the charge now, to reflect the loss of the future tax deduction.
According to David Zion, an analyst at Credit Suisse, the S&P 500 companies will take a combined hit of $4.5 billion to first-quarter earnings.
It seems to us at therubins that corporate America is raising its voice in complaint about this change, when in all reality, the change is one that certainly is more equitable in eliminating a double benefit that corporate America should not have been entitled to in the first place.
For those making more than $200,000, or $250,000 for a couple, the new Act means a boost in the Medicare payroll tax beginning in 2013. That is the same year, the Act adds a tax of 3.8% on unearned income, which includes interest and dividends, above those same thresholds. The tax applies only to the income in excess of the limits.
Thus if a couple earned $200,000 in wages and $100,000 in capital gains, for a total of $300,000, $50,000 (the amount over the $250,000 mark for couples)would be subject to the new tax starting in 2013. If the top income tax rate returns to 39.6%, as President Obama has proposed, investors in the top bracket would pay a total of 43.4% rate on bond interest, including the proposed 3.8% investment tax.
It is estimated that the new tax would affect some four million couples and one million individual filers..
The amount you can put in a tax-free flexible spending account (FSA) will be limited to $2,500 a year starting in 2013. There is currently no legal cap on the amount that an employee can put into his/her flexible spending account, although many employers impose their own limits.
Those who pay for drugs in the "doughnut hole" coverage gap are eligible for a $250 rebate in 2010. In 2011, that group will get a 50% discount on brand-name drugs. The doughnut hole will be gradually eliminated by 2020. This loss of profit for drugs in the "doughnut hole" is where the drug companies came up with the $80 billion over 10 years that they lose as a result of the health-care reform act.
Starting next year, certain preventive care examinations will be free.
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN
SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
By Allan Rubin
updated March 26, 2021