“……We are seeking to empower states with new opportunities that will strengthen their health insurance markets.”
Thomas E. Price, M.D., The Secretary of Health and Human Services (HHS), A Letter To Governors, dated March 13, 2017
On March 13, 2017, the Department of Health and Human Services (HHS) sent a letter to state governors to highlight Section 1332 of the Affordable Care Act (ACA). Beginning in 2017, Section 1332 allows states to apply for a State Innovation Waiver from certain ACA requirements.
With the lawmakers firmly stuck in the healthcare mud, one wonders if some states might start to make health insurance changes on their own. Under a little known provision of the Affordable Care Act (Section 1332) called the State Innovation Waiver, states have the ability to make changes by applying for waivers from certain major provisions of the law beginning this year (2017). These waivers are intended to allow states the flexibility to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance, while retaining some of the consumer protections of the ACA.
Examples of things that may be waived include:
- Establishment of qualified health plans (QHPs);
- Consumer choices and insurance competition through the Exchanges;
- Premium tax credits and cost-sharing reductions for plans offered within the Exchanges;
- The employer shared responsibility rules; and
- The individual mandate.
While this provision and Price’s recent letter on the subject seemingly flew under the radar, you have to wonder if we might start to see some states initiating their own changes to Obamacare. If this is going to happen, we’ll likely start hearing about it in the next few months. Sometime this summer is when carriers submit rate increases or announce intentions to withdraw from the individual market all together. Analysts are predicting both to happen. It’s anticipated carriers will request huge rate increases — sticker shock on steroids — for individual plans on and off exchange. And, more carriers are expected to be leaving the individual market. Aetna and UnitedHealthcare are already out, and Bloomberg recently reported that Anthem (BlueCross and Blue Shield in 14 states) is leaning toward exiting in most if not all of its markets.
I doubt anyone really knows where all this is going, or where it will end up. Maybe some states will act, maybe not.
One thing that’s almost certain: Access to employer sponsored health plans will be more important than any time since Obamacare (ACA) became law.
Here’s a link to more info: HHS Promotes ACA Section 1332 Waivers
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- Tom Barrett
- March 31, 2017
- ACA, affordable care act, cost, costs, coverage, deadline, employees, employers, exchange, federal, health plans, healthcare, healthcare reform, HHS, insurance, medical, Obamacare, penalties, ruling
- 0 Comments
The CMS Data Match program determines whether an employer-sponsored group health plan has the responsibility for paying health care claims before Medicare. As discussed in last week’s post, with the number of workers age 65 and over steadily increasing, many employers are receiving letters from CMS asking for information about their employer-sponsored health coverage. Employers are required to respond or be subject to penalties (fines). This Compliance Overview summarizes these requests for information and highlights the corresponding steps for responding………………Medicare Secondary Payer IRS SSA CMS Data Match.
Medicare Secondary Payer IRS SSA CMS Data Match
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- Tom Barrett
- May 11, 2016
- ACA, affordable, cost, coverage, deadline, DOL, employees, employers, federal, health plans, insurance, medical, Obamacare, penalties
- 0 Comments
Media outlets have been buzzing since Tuesday about the passing deadline of open enrollment and what the next phase of implementing the new health care system will bring. There is a lot of “noise” about whether the 7.1 million number of new enrollees reported by the White House is an inflated number, mostly because many believe there is a large percentage of enrollees who have yet to pay for their insurance. Also, there is a great deal of speculation that insurance companies will raise their rates next year along with reports that indicate the implementation of the new health care system will weigh heavy on large employers, causing their expenses to rise [additionally] by nearly 6% [over and above what they would already spend] over the next ten years.
Kaiser Health News offers a round up of commentary from several sources in
Open Enrollment is Over — What’s Ahead for the Health Law Now?
Meanwhile, Marketwatch by Wall Street Journal reports ADP just released it’s 2014 ADP Annual Health Benefits Report. This is their second annual report, based on actual, aggregated health benefits data from U.S.-based companies with 1,000 or more employees. According to a press release by ADP, “…the report provides employers with benchmarks to better gauge the effectiveness of their current strategies and to help plan for changes on the horizon.”
The data was collected by a survey of employees (anonymous) from a group of employers spanning from 2010 to 2014. Key findings of the report include:
- Premium increases are leveling off
- Employers are contributing slightly less
- Overall participation is steady, but varies with age
- Costs vary by state
You can download a free copy of the ADP report here.
Info for Part-time or Other Employees Currently Without Health Insurance
There’s lots of noise out there related to Obamacare’s individual mandate and the rapidly approaching March 31 open enrollment deadline. Here’s summary information for those part-time or other employees that currently do not have any health insurance:
- The deadline to sign up for individual health insurance is March 31 – less than a week away. This marks the end of the open enrollment period. After March 31, those without coverage will not be able to purchase an individual health plan (on or off the exchange) until the next open enrollment period beginning in November — unless they have a qualifying event such as marriage, birth of a child, loss of employer sponsored health coverage, move out of state, have a significant income change, etc. If that’s the case, then they can enroll during a special enrollment period.
- Extensions may be available based on information released just yesterday. According to latest reports if someone started to apply for coverage through the HealthCare.gov website but could not finish by March 31 or they experienced other glitches in trying to sign up, they will have until about the middle of April to seek an extension. Individuals can qualify for an extension by checking a blue box on the HealthCare.gov website indicating that they’ve tried to enroll before the deadline. The following are links to recent news stories that reported the extension that was officially announced yesterday:
- If someone goes without health coverage after March 31, they may be subject to health reform law’s tax penalty come tax time next April for not having coverage. The penalty this year is $95 or up to 1% of income, whichever is greater.
- Some financial assistance may be available. Individuals and families with incomes between 100 percent and 400 percent of the poverty level (about $11,490 to $45,960 for individuals) may qualify of premium tax credits (also referred to as premium subsidies). Tax credits are based on a percentage of household income and are applied on a sliding scale for those that qualify.
Individuals who want to obtain health care insurance before the March 31 deadline should visit Healthare.gov to begin their application process.