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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.
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.
Labor unions are among the key institutions responsible for the passage of Obamacare. They spent tons of money electing Democrats to Congress in 2006 and 2008, and fought hard to push the health law through the legislature in 2009 and 2010. But now, unions are waking up to the fact that Obamacare is heavily disruptive to the health benefits of their members.
Last Thursday, representatives of three of the nation’s largest unions fired off a letter to Harry Reid and Nancy Pelosi, warning that Obamacare would “shatter not only our hard-earned health benefits, but destroy the foundation of the 40 hour work week that is the backbone of the American middle class.”
The letter was penned by James P. Hoffa, general president of the International Brotherhood of Teamsters; Joseph Hansen, international president of the United Food and Commercial Workers International Union; and Donald “D.” Taylor, president of UNITE-HERE, a union representing hotel, airport, food service, gaming, and textile workers.
“When you and the President sought our support for the Affordable Care Act,” they begin, “you pledged that if we liked the health plans we have now, we could keep them. Sadly, that promise is under threat…We have been strong supporters of the notion that all Americans should have access to quality, affordable health care. We have also been strong supporters of you. In campaign after campaign we have put boots on the ground, gone door-to-door to get out the vote, run phone banks and raised money to secure this vision. Now this vision has come back to haunt us.”
‘Unintended consequences’ causing ‘nightmare scenarios’
The union leaders are concerned that Obamacare’s employer mandate incentivizes smaller companies to shift their workers to part-time status, because employers are not required to provide health coverage to part-time workers. “We have a problem,” they write, and “you need to fix it.”
“The unintended consequences of the ACA are severe,” they continue. “Perverse incentives are causing nightmare scenarios. First, the law creates an incentive for employers to keep employees’ work hours below 30 hours a week. Numerous employers have begun to cut workers’ hours to avoid this obligation, and many of them are doing so openly. The impact is two-fold: fewer hours means less pay while also losing our current health benefits.”
What surprises me about this is that union leaders are pretty strategic when it comes to employee benefits. It was obvious in 2009 that Obamacare’s employer mandate would incentivize this shift. Why didn’t labor unions fight it back then?
Regulations will ‘destroy the very health and wellbeing of our members’
The labor bosses are also unhappy, because of the way Obamacare affects multi-employer health plans. Multi-employer plans, also called Taft-Hartley plans, are health insurance benefits typically arranged between a labor union in a particular industry, such as restaurants, and small employers in that industry. About 20 million workers are covered by these plans; 800,000 of Joseph Hansen’s 1.3 million UFCW members are covered this way.
Taft-Hartley plans, they write, “have been built over decades by working men and women,” but unlike plans offered on the ACA exchanges, unionized workers will not be eligible for subsidies, because workers with employer-sponsored coverage don’t qualify.
Obamacare’s regulatory changes to the small-group insurance market will drive up the cost of these plans. For example, the rules requiring plans to cover adult children up to the age of 26, the elimination of limits on annual or lifetime coverage, and the mandates that plans cover a wide range of benefits will drive premiums upward.
But the key problem is that the Taft-Hartley plans already provide generous and costly coverage; small employers now have a more financially attractive alternative, which is to drop coverage and put people on the exchanges, once the existing collective bargaining agreements are up. That gives workers less reason to join a union; a big part of why working people pay union dues is because unions play a big role in negotiating health benefits.
So the labor leaders are demanding that their workers with employer-sponsored coverage also gain eligibility for ACA subsidies. Otherwise, their workers will be “relegated to second-class status” despite being “taxed to pay for those subsidies,” a result that will “make non-profit plans like ours unsustainable” and “destroy the very health and wellbeing of our members along with millions of other hardworking Americans.” ‘The law as it stands will hurt millions of Americans’
The leaders conclude by stating that, “on behalf of the millions of working men and women we represent and the families they support, we can no longer stand silent in the face of elements of the Affordable Care Act that will destroy the very health and wellbeing of our members along with millions of other hardworking Americans.”
President Obama, of course, pledged that “if you like your plan, you can keep your plan.” But the labor leaders say that, “unless changes are made…that promise is hollow. We continue to stand behind real health care reform, but the law as it stands will hurt millions of Americans including the members of our respective unions. We are looking to you to make sure these changes are made.”
Avik Roy, Contributor Forbes, July 15, 2013
In the next few months you will be hearing about “Exchanges” for businesses & individuals on TV
and radio. The California health insurance exchange will begin to offer plans and enrollment after October 1st. with coverage taking effect January 1, 2014. The new marketplace will offer California Exchange and Off-Exchange health plans in addition to existing private plans. All new health plans will be offered on a guaranteed acceptance basis with all pre-existing conditions covered. More Exchange & Off-Exchange benefit details and rates should be available by August . It usually will only make sense for you to move to a health plan in the State Exchange if you are eligible for a tax subsidy. The Cal State exchange premium assistance offered is only for those who fall between 133% to 400% of the Federal Poverty Level based upon household income.
You can count on us! We’re your key health reform and exchange resource. We are ready to assist you every day–on the phone and in person providing you with time and cost saving programs. Please call us before you do anything with your current coverage and I will advise you on the best course of action that will provide quality coverage and save you money.
You may be better off keeping your existing health plan or alternatively consider the Off-Exchange and California Health Insurance exchange plans which may save you money and provide enhanced benefits. Our services will assist you in applying for a possible tax subsidy, selecting the best health plan, and enrollment process.
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Frank West
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For a year, consumers will be on the honor system for subsidies under the Patient Protection and Affordable Care Act.
That’s what the Obama administration quietly announced Friday, days after unexpectedly announcing they would delay the employer mandate penalty for another year.
In a new 606-page rule published Friday, the administration said they would significantly scale back on the law’s requirements that the new exchanges verify consumers’ income and health insurance status until 2015, when stronger verification systems are in place.
In the meantime, the government will rely on consumers’ self-reported information.
Health insurance exchanges set up under PPACA are set to begin open enrollment Oct. 1. Enrollees with incomes ranging from 100 percent to 400 percent of the federal poverty line are eligible to receive tax subsidies to help them buy insurance. They also must not have access to insurance through their employer to qualify.
“The exchange may accept the applicant’s attestation regarding enrollment in eligible employer-sponsored plan . . . without further verification,” according to the final rule.
The administration has said they would conduct random checks to verify whether new applicants receive employer-sponsored insurance benefits, while also verifying income status.
But the new regulations from the Department of Health and Human Services said the 17 state-based exchanges would have until 2015 to do random checks, citing “legislative and operational barriers.”
In all 50 states, though, the federal government will scale back oversight of what applicants say they earn.
That move, some critics say, could lead some consumers to under report their income in order to qualify for federal tax subsidies, at least in states that are not expanding Medicaid coverage.
In the same rule, the government said it would give states until 2015 to roll out electronic notices because “states are at different places in the development of their eligibility and enrollment systems,” HHS said.
The rule is the latest setback in the health care overhaul law.
Last week, the administration announced it would not require employers with 50 workers or more to provide insurance benefits until 2015, a move business groups applauded but Republicans slammed as confirmation that “Obamacare costs too much and it isn’t working the way the administration promised.”
The administration has said the exchanges and other parts of the law are on target, and they are making delays and changes to better suit the public and employers.
Troy Underwood, CEO of Benefits Connect in Rancho Cordova, Calif. said, though, that he expects to see more PPACA delays and missed deadlines as the months go by.
“Platitudes, political favors and hope never replace a solid and realistic plan,” Underwood said. “As an expert in the processing and administration of employee benefits I can tell you the government’s efforts, even if well-intentioned, are grossly inefficient.
Dan Lopez rarely gets sick and hasn’t been to a doctor in 10 years, so buying health insurance feels like a waste of money.
Even after the federal health overhaul takes full effect next year, the 24-year-old said he will probably decide to pay the $100 penalty for those who skirt the law’s requirement that all Americans purchase coverage.
“I don’t feel I should pay for something I don’t use,” said the Milwaukee resident, who makes about $48,000 a year working two part-time jobs.
Because he makes too much to qualify for government subsidies, Lopez would pay a premium of about $3,000 a year if he chose to buy health insurance.
“I shouldn’t be penalized for having good health,” he said.
Persuading young, healthy adults such as Lopez to buy insurance under the Affordable Care Act is becoming a major concern for insurance companies as they scramble to comply with the law, which prohibits them from denying coverage because of pre-existing conditions and limits what they can charge to older policyholders.
Experts warn that a lot of these so-called “young invincibles” could opt to pay the fine instead of spending hundreds or thousands of dollars each year on insurance premiums. If enough young adults avoid the new insurance marketplace, it could throw off the entire equilibrium of the Affordable Care Act. Insurers are betting on the business of that group to offset the higher costs they will incur for older, sicker beneficiaries.
The nonpartisan Congressional Budget Office estimates that about 6 million people of various ages will pay the tax penalty for not having insurance in 2014, the first year the law championed by President Barack Obama will be fully implemented.
It’s hard to estimate how many of those will be the young and healthy adults that insurers are trying to reach, but that subgroup makes up a very small portion of the overall market. Even though it’s small, experts say it could be enough to throw the system’s financing off-kilter.
About 3 million 18-to-24-year-olds in the U.S. currently purchase their own insurance. Many pay high prices for scant benefits, with high deductibles and co-pays because they make too much to qualify for Medicaid and have no coverage options from their employers or parents. The Urban Institute estimates that the majority of adults in their 20s will qualify for government subsidies under the Affordable Care Act.
Premium hikes could be a disincentive for young people weighing their options. Premiums for people aged 21 to 29 with single coverage who are not eligible for government subsidies would increase by 42 percent under the law, according to an analysis by actuaries at the consulting firm Oliver Wyman. By comparison, an adult in his or her early 60s would see about a 1 percent average increase in premiums under new federal health rules.
“The key to keeping health care affordable is you really want to balance the pool, where you have enough young and healthy people to balance off the care of the older, sicker people who are likely to utilize much more health care services,” said Justine Handelman, the Blue Cross and Blue Shield Association’s vice president for legislative and regulatory policy.
She said younger people use about a fifth of the services that older beneficiaries do.
Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology who helped craft that state’s law, said he thinks the first-year federal penalty should be higher.
The penalty under the Massachusetts law, which served as the model for Obama’s overhaul, was $218 the first year in 2007. Gruber said that amount proved effective.
“People hate paying money and getting nothing for it,” he said.
Francois Louis, a 20-year-old college student in South Florida who works part-time, can’t remember the last time he went to the doctor and gets by on over-the-counter medication whenever he’s sick. He’d love to get a checkup, but says it’s too expensive on his income of less than $15,000 a year.
“I probably would do the $100 fine because it’s just cheaper and you don’t have to worry about paying off monthly costs,” said Louis, a student at Broward Community College near Fort Lauderdale.
By Kelli Kennedy
The Associated Press
The Obama administration’s move to delay until 2015 a requirement that employers offer health insurance or else face stiff penalties is yet another indication that the embattled law is a failure and should be repealed, Republicans and conservatives said on Tuesday.
“The president’s healthcare law is already raising costs and costing jobs,” House Speaker John Boehner said. “This announcement means even the Obama administration knows the ‘train wreck’ will only get worse.
“I hope the administration recognizes the need to release American families from the mandates of this law as well,” the Ohio Republican said. “This is a clear acknowledgment that the law is unworkable, and it underscores the need to repeal the law and replace it with effective, patient-centered reforms.”
“Obamacare costs too much and it isn’t working the way the administration promised,” said Senate Minority Leader Mitch McConnell of Kentucky. “The White House seems to slowly be admitting what Americans already know: Obamacare needs to be repealed and replaced with common-sense reforms that actually lowers costs for Americans.”
And Barney Keller, spokesman for the Club for Growth, called the delay “a transparently political ploy to help the Democrats who voted for it avoid the consequences at the ballot box in 2014. This just helps make the case that Obamacare should be completely repealed — period, exclamation point.”
The IRS, which is charged with implementing Obamacare, remains under fire for widespread mismanagement and for the targeting of tea party, conservative, and religious groups in evaluating their applications for tax-exempt status.
And the American Action Forum, a Washington advocacy group, said that Obamacare had so far cost a total of $30.8 billion and 111.4 million hours for completing paperwork alone.
The group said 55,742 employees — working 2,000 hours per year — would be needed to process all the red tape associated with Obamacare.
While the employer mandate was delayed with Tuesday’s announcement, the individual mandate — which requires individuals to obtain health insurance — presumably remains on schedule for 2014.
The announcement tonight of the delay of part of the implementation of Obamacare prompted Speaker of the House John Boehner to release this statement, saying the entire bill is a “train wreck” and “unworkable.”
“The president’s health care law is already raising costs and costing jobs. This announcement means even the Obama administration knows the ‘train wreck’ will only get worse. I hope the administration recognizes the need to release American families from the mandates of this law as well. This is a clear acknowledgment that the law is unworkable, and it underscores the need to repeal the law and replace it with effective, patient-centered reforms,” the statement reads.
Being self-employed is a liberating feeling for those who make it a part of their lifestyle. These people have the autonomy to set their own schedule, and enhance their careers as much as possible without having to deal with mundane office politics. A self-employed person can manage their own career, without having to wait to be promoted. There is one thing however, that is tough to manage, which is health insurance.
When first starting out in a new career, it can be especially difficult to carry health insurance. Although many people would love to become self-employed, and plan carefully for such an event, most do not realize the actual monthly expense of health insurance. Before you make this decision, it is crucial to figure out exactly how much you will be paying for health insurance. Collect as much information as possible, for example the rates you need to pay to cover yourself and possible dependents, and how that fits into your budget.
Being self-employed does not allow you to take advantage of bulk rates that are normally set aside for employers paying to cover their employee’s health insurance costs. This is one of the reasons why the insurance rates are so high. Through careful research, you may find you have access to low bulk insurance rates through a non-corporate affiliation. Possible solutions include programs related to educational institutions you may be associated with, or perhaps your religious background will allow you to get a discount from certain organizations.
Consider joining a group that can help get you an affordable insurance rate. The Freelancer’s Union was formed partly to help the self-employed get health insurance at discounted rates by bringing freelancers together. Take into account nationwide organizations like the Freelancer’s Union as well as local community organizations that will give you options for insurance rates. It’s just a matter of being resourceful and creative to find health insurance as a self-employed person.
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