Obamacare Navigators get $67 million in grants.

August 15, 2013 by Frank West

CHICAGO (AP) — President Barack Obama’s administration has announced $67 million in awards to organizations that will help people sign up for insurance under the new health care law.

Health and Human Services Secretary Kathleen Sebelius announced Thursday the Navigator grant awards to 105 organizations in states that are letting the federal government run their online insurance marketplaces.

The Navigator program will be particularly important to the health law’s success in some Republican-led states that aren’t doing any state-directed outreach to the uninsured.

The grant winners don’t have much time to hire and train outreach workers. Enrollment for the health law’s new coverage options starts Oct. 1, and benefits kick in Jan. 1.

Navigators must complete a training program developed by the federal government and pass an exam.

PPACA navigators to earn $20-$48 an hour.

Filed Under: Affordable Care Act, Health Care Reform, Health Insurance Exchange, Navigators Tagged With: Affordable Care Act, Health Care Reform, Health Insurance Exchange, Navigators

Consumer Cost Protection in Obama Health Plan Is Delayed.

August 15, 2013 by Frank West

Federal regulators have delayed a consumer protection in President Barack Obama’s signature health law that limits the out-of-pocket costs of people with insurance.

The one-year postponement of the annual limit on costs that patients must pay above what their insurance covers is another setback for a health-care law that has met resistance from Republicans and faced delays in enforcement of other key provisions.

The White House announced on July 3 that it would postpone, also for one year, the so-called employer mandate, which requires companies with 50 or more workers to provide health insurance to employees.

The limit on out-of-pocket costs, such as deductibles and co-payments, was supposed to be $6,350 for an individual and $12,700 for a family beginning in 2014. Federal officials now will allow some insurers to wait until 2015 to comply with the consumer protection.

The one-year postponement applies only to group health plans such as those offered by employers and unions and only to plans which use independent managers to handle pharmaceutical or other benefits, said an administration official who asked not to be identified speaking about internal deliberations.

Individual policies sold in the new marketplaces created by the health care law still must comply on schedule with the overall limits on out-of-pocket costs included in the health care law, the official said.

Filed Under: Affordable Care Act Tagged With: Affordable Care Act, Health Care Reform, Health Insurance Exchange

In About-Face, Aetna Backs Away from State-Based Exchanges.

August 13, 2013 by Frank West

At least one big insurer is rethinking its plans to sell healthcare policies through the state and federal online marketplaces next year.

Aetna has dropped plans to offer health policies through the insurance exchanges in Ohio and its home state of Connecticut, the company revealed last week.

The Buckeye and Nutmeg state exchanges are the latest to join a growing list of local markets in which the carrier has reversed course and decided not to participate. Since June, it has also backed off plans to sell coverage via the exchanges in six other states, including California, Georgia, Maryland, New York, Tennessee and Texas.

In the case of Connecticut, at least, the decision was made “reluctantly,” according to a letter to the state’s Insurance Department signed by Bruce Campbell, Aetna’s senior actuary. “Please be assured this is not a step taken lightly, and was made as part of national review of our Exchange strategy,” Campbell wrote.

As in some other states, Aetna abandoned its plans after Connecticut regulators questioned the rates it proposed to offer through the state’s exchange, known as Access Health CT or AHCT. Three insurers will still offer individual coverage through AHCT, including Anthem, ConnectiCare and the nonprofit HealthyCT.

“The good news today is that consumers and businesses will retain several, high quality choices, and today’s decision also shows we at AHCT are doing our best to hold rates down,” Kevin Counihan, the chief executive of AHCT, said in a statement. “Our goal is clear: we want to bring affordable, quality health care to Connecticut’s residents and small businesses.”

The story is similar in Maryland, where the insurer said the state’s requirements for rate reductions would force it to operate at a loss. “Unfortunately, we believe the modifications to the rates filed by Aetna and Coventry would not allow us to collect enough premiums to cover the cost of the plans,” Aetna said in a letter to insurance commissioner Therese Goldsmith. Eight other carriers will continue to offer individual policies through Maryland’s web-based insurance market.

In Ohio, Aetna said it’s withdrawing from the individual exchange market for 2014, but plans to continue offering its individual products from its Coventry subsidiary on the exchange. The carrier also said it will continue to provide its individual product in Ohio’s off-exchange market.

Aetna’s decision will leave 12 companies offering 200 individual health insurance plans on the Ohio exchange.

Filed Under: Affordable Care Act, Health Insurance Exchange Tagged With: Affordable Care Act, Health Insurance Exchange, individual mandate

WSJ Rips New Obamacare Exemption for Congress.

August 8, 2013 by Frank West

The administration’s new rules that allow members of Congress and their staffs to escape the healthcare exchanges under Obamacare represent a double standard, according to a Wall Street Journal editorial.

It boils down to “illegal dispensations for the ruling class, different rules for the hoi polloi,” the Journal said Thursday.

Obamacare stipulates that “the only health plans that the federal government may make available” to Congress are the ones that are part of the law’s insurance exchanges.

But that requirement set off complaints among members and their aides, “because they won’t qualify for Obamacare subsidies and they’ll lose employer contributions they now receive under the Federal Employees Health Benefits Program (FEHBP),” the Journal said.

The Journal criticized President Barack Obama for personally instructing the Office of Personnel Management to retain the congressional benefits.

“The eat-your-own-cooking provision begins with the phrase ‘Notwithstanding any other provision of law.’ The feds now interpret that clause as a loophole to mean that the Affordable Care Act did not change the 1959 law that created the FEHBP.”

That means congressional employees can remain enrolled in the FEHBP at the same time that they use Obamacare exchanges.

“The feds then ‘clarify’ — their euphemism — that the regulatory meaning of health benefits in the FEHBP can be Obamacare plans. Voila, taxpayers will continue to chip in $4,900 for individual and $10,000 for family coverage,” the editorial continued.

The lawmakers and their aides will still have to use the exchanges, as required by law, but only because it would have been “too explosive politically” not to, the Journal said.

The Journal said Congress would have done better to create a law offering its workers a raise to make up for the loss of government benefits and subsidies.

“But that would mean an ugly political fight that voters might notice. It’s so much easier to slip through this political fix in August when Congress is out of session and the press corps can’t wait to hit the beach,” the newspaper said.

Filed Under: Affordable Care Act, Obamacare Tagged With: Affordable Care Act, Health Care Reform, Obamacare

House Passes Bill To Keep IRS From Enforcing Obamacare.

August 8, 2013 by Frank West

House Passes Bill To Keep IRS From Enforcing Obamacare

Today, the House passed the Keep the IRS Off Your Health Care Act of 2013. The purpose of the bill, H.R. 2009, as introduced by Rep. Tom Price (R-GA), is simple: to prohibit the Secretary of the Treasury from enforcing the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.

Filed Under: Affordable Care Act, Obamacare Tagged With: Affordable Care Act, Health Care Reform, Obamacare

Labor unions are having problems with the way Obamacare harms their gold-plated health benefits .

August 7, 2013 by Frank West

Labor unions are having problems with the way Obamacare harms their gold-plated health benefits http://bit.ly/1cG4Zfr The Apothecary, With Avik Roy Forbes. Insights into health care and entitlement reform.

Filed Under: Affordable Care Act, Employer Mandate, Group Health Insurance, Obamacare Tagged With: Affordable Care Act, Obamacare

Experts: Obamacare will lead to massive spying on US health records.

August 7, 2013 by Frank West

Experts: Obamacare will lead to massive spying on US health records

Jul 24, 2013 … The federal government may be one step closer to keeping tabs on consumers’ health care information with a new data hub under Obamacare.

dailycaller.com/2013/07/24/experts-obamacare-will-lead-to-massive-spying-on-u-s-health-records/

Filed Under: Affordable Care Act, Health Care Reform, Obamacare Tagged With: Affordable Care Act, Health Care Reform, Obamacare

Delay of employer penalties will cost gov’t $10 Billion.

July 30, 2013 by Frank West

WASHINGTON (AP) — The Obama administration’s surprise decision to delay a key requirement of the health care law for employers will cost the government $10 billion, the nonpartisan Congressional Budget Office said Tuesday.

While that’s a big number, the report from the official budget scorekeeper for Congress also put the administration’s recent move within a wider perspective. Overall, the delay for employers and other changes will raise the cost of the expanding coverage for the uninsured by less than 1 percent over 10 years from the budget agency’s previous estimate in May, CBO said.

The White House announced earlier this month that it would delay a requirement for employers with 50 or more workers to offer affordable coverage, or face fines. Instead of going into effect next year, the provision was put off to 2015. A major concession to business groups, the delay took administration allies and adversaries by surprise.

Opponents of the health care law saw the delay as a sign that the implementation of the measure had run into serious problems, and some labor unions denounced it as a handout to big business. But employers welcomed the unexpected respite from complicated reporting rules that the administration concedes will require more time to work out. The White House says the rest of the law’s provisions will roll out without delay.

Uninsured people without access to coverage at work will be able to start shopping for a health plan Oct. 1. Middle-class people will be able to pick from a range of private insurance plans, with new federal tax credits to help pay their premiums. Low-income people will be steered to an expanded version of Medicaid, in states that accept it. Coverage takes effect Jan. 1.

At the same time, most Americans will face an individual requirement to carry health insurance or pay fines. That’s designed to expand the number of healthy people in the pool, since the law forbids insurers from turning away people with pre-existing health problems.

All told, about 13 million of nearly 50 million uninsured U.S. residents are expected to gain coverage in 2014, according to the latest CBO estimates. That number is expected to gradually increase to between 25 million and 30 million people.

The budget office said fewer than half million people will have to forgo coverage as a consequence of the delay in the so-called employer mandate. The delay “will have only a negligible effect on sources of insurance coverage,” the report said.

The government will lose $10 billion in fines that would have collected from employers in the first year of the requirement, the report said. Other last-minute changes by the administration are estimated to add another $2 billion in costs, for a total increase in the cost of $12 billion over 10 years.

However, the impact on the bottom line does not appear to be major — at least in terms of the federal budget.

CBO estimated that the cost of expanding coverage under the law will rise to $1.375 billion from 2014-2023, an increase of less than 1 percent from the agency’s previous cost estimate of $1.363 billion.

Filed Under: Affordable Care Act, Employer Mandate, Health Care Reform Tagged With: Affordable Care Act, Employer Mandate

Detroit Looks to Obamacare to Cover Pensioners’ Health Care.

July 30, 2013 by Frank West

Detroit is hoping to lean on the Affordable Care Act to pick up its massive retiree health care tab as it tries to dig it out of bankruptcy.

The Motor City is reportedly considering shifting its unfunded $5.7 billion in health-care costs of retired workers that aren’t yet eligible for Medicare to the health insurance exchanges that are set to hit the market next year under Obamacare.

The $9 billion in pension liabilities to 21,000 retirees is the greatest cost to the city, which is currently $18 billion in debt, according to the Detroit Free Press.

If the current pension health-benefits are cut, the majority of retirees will either receive care via Medicare if they are at least age 65, or through online insurance exchanges. Those who are at or below 400% of the federal poverty limit will be eligible for subsidies.

“It will actually be discriminatory,” says Gary Burtless, labor expert at the Brookings Institute. “Suppose you are a retiree and you believe you had access to Detroit-provided health insurance plans, but your family income is over four-times the poverty line. You will not get any subsidy and will have to pay for the full cost of the plan without any help of the government, in any form, whatsoever.”

He adds that Detroit retirees are lucky in one sense, since they are Social Security-eligible. In some states, including Massachusetts, public workers cannot collect Social Security benefits because they do not pay into the system. With that said, Detroit retirees depending on a pension might be forced to claim Social Security benefit early, and thus reducing their payments.

But what may be good news for Detroit retirees who are eligible for the health-care subsidy, is bad news for taxpayers, who are helping pay for this coverage for an unnamed amount of pensioners in the city who are not yet Medicare eligible, says Michael Tanner, Cato Institute senior fellow.

“It’s a shift of the cost to these [retired] workers and to the taxpayers at large,” Tanner says. “If Detroit went to Congress and asked them to pay for their plans, Congress would say, ‘no.’ They are getting a bailout from taxpayers.”

The average pension check, per month for a retiree in Detroit is under $1,200 according to the Detroit Free Press. Using the Kaiser Family Foundation’s subsidy calculator, a single, 63-year-old worker receiving a $1,200 check per month, or $14,400 pre-tax per year, would be at 125% of the federal poverty level. This worker seemingly does not smoke, and has no children or other family members on the health-care plan.

Kaiser’s calculator has the unsubsidized annual premium for our fictional worker at $3,018, and the worker paying $288 for care per year.

Other cash-strapped cities and municipalities are watching the situation in Detroit closely, as it may provide financial options to unfunded pension systems, says Tanner.

“This is being talked about in a number of cities,” he says. “The fact is that Detroit will have to cut its health-care plans and this is a way of shifting those costs.”

And if Detroit pulls this off successfully, Burtless thinks many other cities will follow suit.

“If Detroit pulls this off, why shouldn’t other cities and states not evade their responsibilities and commitment?”

Whether this is the solution the city opts for will all depend on its bankruptcy restructuring plan, Tanner says. City Emergency Manager Kevyn Orr has discussed a potential $120 allowance for retirees who were set to receive full health-care benefits before the Chapter 9 filing, says Steven Kreisberg, director of collective bargaining at Detroit’s AFSCME union.

Kreisberg says if the shift occurs, it will bring a reduction in benefits for retirees.

“The ACA has various ranges of coverage, but it will depend on what the retirees are willing to pay,” he says. “You are moving from a situation where employees earned the right to retiree health care to [a situation] where that will be completely withdrawn.”

Solutions to the city’s pension and retiree benefits are still very much in the “discussion” phase, says Kreisberg.

“It’s a significant loss,” he says. “The coverage employees had was seamless from employment to retirement and was very comprehensive. “

Filed Under: Affordable Care Act, Health Insurance Exchange Tagged With: Affordable Care Act, Health Insurance Exchange

The benefits and pitfalls of buying insurance on health-care exchanges.

July 30, 2013 by Frank West

The benefits and pitfalls of buying insurance on health-care exchanges.

As the state health insurance marketplaces, also called exchanges, get set to launch in October, many people have questions about the coverage that will be offered there. Here are a few that were posed to me recently:

Q. Are there unintended consequences of shopping through an exchange? For example, are the benefits of a plan with a lower monthly premium less comprehensive than the benefits of an expensive plan? And are there plans available only to people who qualify for subsidies, so that once income increases, the consumer must switch to a different plan?

A. All plans sold on the exchanges must cover 10 so-called essential health benefits, including prescription drugs, emergency and hospital care, and maternity and newborn care.

For the most part, the plans will differ not in which benefits they cover but in the proportion of costs that consumers will be responsible for paying.

There will be four basic types of plans: Platinum plans will pay 90 percent of the cost of covered medical services, on average; gold plans will pay 80 percent; silver plans will pay 70 percent; and bronze plans, 60 percent. Premiums will vary based on those percentages, so platinum plans generally will be pricier than bronze ones.

Individuals and families with incomes up to 400 percent of the federal poverty level ($45,960 for an individual and $94,200 for a family of four in 2013) may be eligible for federal tax credits to help pay premiums.

Consumers “can use the premium subsidy to purchase any plan,” says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.

If your income increases during the year, you may no longer qualify for the same level of assistance, but you won’t have to switch plans. However, you may have to repay any overpayments that were made to insurers if your projected income turns out to be higher than your actual income. On the other hand, if your income falls, you may be eligible for a larger tax credit. That’s why it’s important to report any income changes to the exchange promptly.

A second type of subsidy available on the exchanges will reduce the amount that people owe in co-payments, deductibles and other out-of-pocket costs. The cost-sharing subsidy is available to individuals and families with incomes up to 250 percent of the poverty level ($28,725 for an individual and $58,875 for a family of four in 2013). To qualify for this subsidy, you must buy a silver plan, Park says. If your income changes, however, you won’t be responsible for any overpayments.

Once the exchanges open, how much will an insurer be allowed to increase premiums annually? And are those increases based on claims?

Premium increases are driven by many factors, including medical costs and the health of the people covered by a particular plan.

The Affordable Care Act discourages insurers from imposing unreasonable premium increases in a couple of ways. Insurers in the small-group and individual markets that want to raise premiums by 10 percent or more must submit data, projections and other information to justify the increase to state or federal regulators, who review the requests and make the information available to the public at. Asking insurers to justify why they want to increase rates should act as a deterrent to unreasonable increases, experts say.

But the law doesn’t give regulators new authority to refuse rate increases, says Timothy Jost, a law professor at Washington and Lee University in Lexington, Va. It does, however, provide funding for states to beef up their rate-review processes.

The Department of Health and Human Services says that increased scrutiny of insurance rates has led to a decrease in rate increases, says Jost, “and that’s probably true.”

In addition, the law requires insurers to spend at least 80 percent of the money they collect in premiums on medical claims and quality improvements rather than on administrative activities such as marketing. If they exceed that limit, they must rebate the excess to consumers. Insurers will return $500 million to 8.5 million consumers — about $100 per eligible family — by mid-August of this year for overcharges in 2012, according to the Obama administration. Rebates may come in various ways, including a check or a reduction in the following year’s premium.

My parents are legal immigrants over 65 but not yet eligible to buy into Medicare because they haven’t lived in the United States for five years. Will they be able to buy health insurance on the federal exchange?

Yes, legal immigrants will be able to shop for coverage on the exchanges, where they may be eligible for premium tax credits if their income is no more than 400 percent of the federal poverty level ($62,040 for a couple in 2013). Immigrants living in the United States illegally, on the other hand, are not permitted to buy coverage on the exchanges even if they wish to pay the entire premium out of pocket.

Filed Under: Affordable Care Act, Health Care Reform, Health Insurance Exchange, San Diego Health Insurance Tagged With: Affordable Care Act, Health Insurance Exchange

PPACA navigators to earn $20-$48 an hour.

The benefits and pitfalls of buying insurance on health-care exchanges.

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