The White House Doubles Down On Republicans Request To Delay The Individual Mandate

LONELY OBAMACARE NAVIGATOR (2)

Pictured: Navigator Dealing With The Public’s Not So Mad Rush To Enroll

**************************************************************************************************

The White House has doubled down on the Republican’s November request to delay the “Individual Mandate” of the Affordable Care Act.

At least a major portion of it.

The only thing predictable about implementation of the Affordable Care Act is that . . . nothing is predictable. On Wednesday, the Obama Administration played “tooth fairy” to Democrat candidates up for re-election this November and gave American individuals and families with pre-2014 health insurance policies a reprieve on the mandate to purchase ACA compliant coverage for two years through 2016. Last fall the House argued and passed a bill allowing American individuals and families who liked their current health plan – to keep their health plan. As the President had originally promised they could do. But for just one year. Now, in what appears to be an entirely self-serving and purely political move to mitigate a loss of Democratic seats in the up-coming mid-term elections, the Administration Obama says . . . “Errrr – of course! You can keep your plan for two more years!” It is quite apparent the Democrats have correctly determined the backlash from plan cancellations mandated by law could be devastating in terms of their election. Therefore, they speculate, with this aspect of the law deferred they will fair much better at the polls.

As a health insurance broker, I must admit I feel this is something of reprieve for myself and many of my clients. My clients can keep their lower cost plans which, in Texas, average approximately 40% higher than pre-compliant plans (approximately 80% higher in Indiana and Ohio – not to mention a dearth of PPO options as opposed to the restrictive HMO options). As for me, I can cease worrying, for now, about losing clients en masse who would otherwise be forced off their existing plans and might go elsewhere for replacement coverage. I can also anticipate obtaining entirely new clients who choose to elect a new plan in order to cover a pre-existing condition or just to comply with the law. And therein lies the rub. Just because the White House says those who have a plan can keep their plan, does not mean the individual states or the insurance companies will agree to this. And for many, it is far too late – their policies already having been canceled. But–furthermore–this reprieve apparently does not carry over to those who have no coverage whatsoever. They must still acquire coverage by March 31st or be assessed the penalty and locked out of insurance for the remainder of 2014. (Unless, of course, they are also eventually granted clemency by the President.)

And how does your editor feel about this from an actuarial standpoint relative to the insurance companies and the ACA itself? In four words: “Politically Pragmatic Voodoo Economics”. Even Obamacare architect Ezikiel Emanuel, stated Wednesday while on MSNBC, that while he denounced the policy implications of yet another Obamacare delay, “for the political gain, it’s worth it”. Unabashedly self-serving.

If the insurance companies comply, they are once again forced to flex at the last minute and be left with two separate blocks of business. One old block containing less claim’s risk. And one new block where the only motivation to insure oneself will be to transfer personally large risk to the insurance company. This will be in terms of pre-existing conditions which were previously manageable or that arise for the first time. As evidence of this, in an attempt to limit the disruption to the insurance industry precipitated by this latest modification, the Department of Health and Human Services also announced yesterday that the “risk corridor” program (which has been described as a bailout to insurers) would be further modified to channel more money to the insurers in states affected by the change. This only reinforces my opinion that those behind this bill are not economists and never cared about the financial viability of this law. They are, however, very concerned with maintaining their political lives at all cost.

Admin. – Kenton Henry

http://allplanhealthinsurance.com

http://thewoodlandstxhealthinsurance.com

****************************************************************************************************

FEATURE ARTICLE:

THE NEW YORK TIMES

Politics

Consumers Allowed to Keep Health Plans for Two More Years

By ROBERT PEARMARCH 5, 2014

WASHINGTON — The Obama administration, grappling with continued political fallout over its health care law, said Wednesday that it would allow consumers to renew health insurance policies that did not comply with the new law for two more years, pushing the issue well beyond this fall’s midterm elections.

The reprieve was the latest in a series of waivers, deadline extensions and unilateral actions by the administration that have drawn criticism from the law’s opponents and supporters, many saying President Obama was testing the limits of his powers.

The action reflects the difficulties Mr. Obama has faced in trying to build support for the Affordable Care Act and the uproar over his promise — which he later acknowledged had been overstated — that people who liked their insurance plans could keep them, no matter what.

Under pressure from Democratic candidates, who are struggling to defend the president’s signature domestic policy, Mr. Obama in November announced a one-year reprieve for insurance plans that did not meet the minimum coverage requirements of the 2010 health care law.

The Times would like to hear from Americans who have signed up for health care under the Affordable Care Act.

Wednesday’s action goes much further, essentially stalling for two more years one of the central tenets of the much-debated law, which was supposed to eliminate what White House officials called substandard insurance and junk policies.

The extension could help Democrats in tight midterm election races because it may avoid the cancellation of policies that would otherwise have occurred at the height of the political campaign season this fall.

In announcing the new transition policy, the Department of Health and Human Services said it had been devised “in close consultation with members of Congress,” and it gave credit to a number of Democrats in competitive races, including Senators Mary L. Landrieu of Louisiana, Jeanne Shaheen of New Hampshire and Mark Udall of Colorado.

Kathleen Sebelius, the secretary of health and human services, said Mr. Obama was trying to “smooth the transition” to a new system, using flexibility that exists under the law.

The move reflects the administration’s view that a divided Congress would not be willing to make changes to the law, but lawyers questioned the legitimacy of the action and said it could have unintended consequences in the long run.

“I support national health care, but what the president is doing is effectively amending or negating the federal law to fit his preferred approach,” said Jonathan Turley, a law professor at George Washington University. “Democrats will rue the day if they remain silent in the face of this shift of power to the executive branch.”

Mr. Turley said Mr. Obama was setting precedents that could be used by future presidents to delay other parts of the health care law or to suspend laws dealing with taxes, civil rights or protection of the environment.

Republicans said the move confirmed their contention that parts of the health care law were ill conceived and unworkable.

The number of people with noncompliant coverage is not known. Insurers sent out perhaps 4.5 million cancellation notices last fall, but some of the policyholders have bought new coverage that complies with the law. Administration officials said that the number of people with noncompliant policies would shrink by attrition in the next two years.The health care law sets dozens of federal standards for insurance, requiring coverage of services in 10 specific areas and providing many consumer protections not found in older policies.Under the transition policy announced by Mr. Obama in November, insurers “may choose to continue coverage that would otherwise be terminated or canceled.” Insurers were allowed to renew existing policies even if they did not provide the “essential health benefits” prescribed by law. 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.

A White House official said Wednesday that it would allow insurers to continue existing policies with renewals as late as Oct. 1, 2016, so individuals and small businesses could have noncompliant coverage well into 2017.

Under another policy announced by the administration on Wednesday, certain health plans will be exempt from new fees imposed on insurance companies and on many self-insured group health plans. Labor unions had been lobbying for such an exemption, saying the fees could be “highly disruptive” to Taft-Hartley plans administered jointly by labor and management representatives in construction, entertainment and other industries.

The Times would like to hear from Americans who have signed up for health care under the Affordable Care Act.

Wednesday’s action goes much further, essentially stalling for two more years one of the central tenets of the much-debated law, which was supposed to eliminate what White House officials called substandard insurance and junk policies.

The extension could help Democrats in tight midterm election races because it may avoid the cancellation of policies that would otherwise have occurred at the height of the political campaign season this fall.

In announcing the new transition policy, the Department of Health and Human Services said it had been devised “in close consultation with members of Congress,” and it gave credit to a number of Democrats in competitive races, including Senators Mary L. Landrieu of Louisiana, Jeanne Shaheen of New Hampshire and Mark Udall of Colorado.

Kathleen Sebelius, the secretary of health and human services, said Mr. Obama was trying to “smooth the transition” to a new system, using flexibility that exists under the law.

The move reflects the administration’s view that a divided Congress would not be willing to make changes to the law, but lawyers questioned the legitimacy of the action and said it could have unintended consequences in the long run.

“I support national health care, but what the president is doing is effectively amending or negating the federal law to fit his preferred approach,” said Jonathan Turley, a law professor at George Washington University. “Democrats will rue the day if they remain silent in the face of this shift of power to the executive branch.”

Mr. Turley said Mr. Obama was setting precedents that could be used by future presidents to delay other parts of the health care law or to suspend laws dealing with taxes, civil rights or protection of the environment.

Republicans said the move confirmed their contention that parts of the health care law were ill conceived and unworkable.

But Republicans denounced the change. “The administration’s decision to carve out its union cronies from the Obamacare fee is beyond egregious and will leave others with self-insured plans on the hook to foot the bill,” said Senator John Thune, Republican of South Dakota.

Robert Laszewski, a consultant who works closely with insurers, said the reprieve for noncompliant policies “tends to undermine the sustainability of Obamacare” by reducing the number of people who will buy insurance through the exchanges.

The administration acknowledged that its transition policy could lead to “higher average claims costs” for people who buy insurance that complies with the Affordable Care Act. But health officials said the 2010 law provided several “shock absorbers” to help stabilize premiums.

http://thewoodlandstxhealthinsurance.com

http://allplanhealthinsurance.com

Who Needs the Healthcare.gov Website?

HEALTHCARE DOT GOV 2

Op-ed by Kenton Henry

If the administration and main stream media will not tell you–I will:

You can go through me–or any licensed health insurance agent or broker to acquire health insurance. NOW. And this is whether you qualify for a subsidy or not. And, importantly, there will be no, I repeat – $0 difference in your cost (premium) for doing so vs. the government website Healthcare.gov or a private insurance company’s. Period. Now where have you heard “Period” before and it turned out to be true? Well . . . in this case it is.

There is only ONE reason to go to the still basically inoperable, security in doubt, aforementioned federal government health insurance website known as The Marketplace:

1) You qualify for a subsidy of your 2014 health insurance premium and you would like to take advantage of that subsidy as you pay your premiums. I.e., you qualify and would like the premium you pay to your insurance company to be reduced by the amount of your subsidy as you pay the premium. (This as opposed to paying the gross premium (cost before your subsidy is applied) then declaring your subsidy on your 2014 tax return and having your tax liability reduced accordingly.)

If you this does not describe you – there is absolutely no reason to go to healthcare.gov!

Neither do you need to go through a state appointed, federally funded Navigator, hired by the State and required to complete only 20 hours of online education and be subjected to no background check. Why replicate and risk the possible insecurity of your personal information which includes your address; birth date; social security number and reported income by going through someone not even vetted by the Department of Health and Human Services (HHS) or the Center for Medicare Services (CMS)? As the Secretary for HHS, Kathleen Sebelius, admitted under oath and questioning from Texas Senator John Cornyn during Congressional, hearings just last week – “It is possible (for a convicted felon to be hired as a Navigator and take your personal and vital information).”

This begs the question: Why is the administration and main stream media not advertising, and barely mentioning, that a health insurance shopper can go through a licensed and vetted insurance agent who has passed a background check with every company with whom they are appointed and do so at no additional cost? Or that the shopper can then have all the expertise that that agent’s time in the industry (27 years in my case) brings to bear on their needs and situation? Or how about a “go to” advocate in their behalf they can call whenever there is an issue relating to claims; rates or general service related issues such as changes in address or dependents. This as opposed to a different unknown service rep at the end of a toll free number each time they call an insurance company directly?

I will let you speculate on the answers to these questions but (while the purpose of this blog is to educate the follower on issues relating to health and Medicare insurance) indulge me while I for once engage in a little shameless self-promotion on behalf of myself and all licensed agents and brokers:

If you reside in Texas; Indiana; or Ohio – please visit my website at http://allplaninsurance.com and click on the bold red “Get A Quote!” button on the home page or–better yet–call me toll free @ 800.856.6556 and let’s have an intelligent dialogue about your true wants and needs relative to coverage and then get some meaningful quotes and information for you. All without submitting the equivalent of a home mortgage application!

If you reside in any other state – do yourself a favor and call a well recommended licensed health insurance agent or broker in your community.

Again, call me even if you do qualify for a subsidy. I can help you just the same and–as without a subsidy–your cost for insurance will be the same. If you do not want to take the subsidy now but would rather take it on your 2014 tax return (when you actually know what your income will have been) we can apply for you now and have your coverage issued immediately.

If you want the subsidy applied upfront, to reduce the premium you pay each month, we will still have to enter the healthcare.gov website. But we will do so only after we have obtained your gross quotes via my website. I know the formula and can do a pretty fair job of estimating your net premium (after your subsidy is applied). If this scenario describes you,  as the federal website is still inoperable, we should wait and see if HHS and CMS have the site fixed and secure by November 30th as promised. Let’s keep our fingers crossed and–if so–we should sail (wink, wink) through the application and have your coverage issued by January 1. But remember, if all government deadlines remain as now, we will need to complete your application no later than December 15th!

Admin. – Kenton Henry

http://allplanhealthinsurance.com

It Was My Impression The Current Administration Has Always Supported Greater Regulation!

Please correct me if I am wrong, but I recall that ever since President Obama took office in 2009–in the midst of the housing crisis; failed savings and loans and with the legacy of Enron still looming fresh in the memories of stockholders everywhere– he has said more government regulation through stricter laws and scrutiny (among a host of other burdensome and expensive supposed remedies) was necessary to protect the consumer and public in general. Now–in a narrative of unabashed hypocrisy his administration speaks out and intervenes to prevent Texas’s Governor Rick Perry from doing that very thing.

 
Perry directed the Texas Department of Insurance to establish strict rules to regulate Navigators trained to help Texans purchase health insurance under the Affordable Care Act (ACA). (These rules are outlined in our feature article below.) Remember – when you go through one these Navigators to enroll in an ACA compliant health plan for an effect date of January 1 – you will be required to divulge your income; your birth date; social security number; address; credit card and checking account information. Do you really want just anyone taking this information? Do you really want the person taking it to not be subject to criminal and financial background checks? Insurance agents licensed in the State of Texas are subject to all these requirements. Why would the administration which always argues for more protection of the individual from the misfeasance, malfeasance and just plain greed of the big corporations, e.g., health insurance companies – now be opposed to such? Why is this regulation so suddenly a liability? Please weigh in and help me understand this. The arguments presented by the fed below do not.

 
Admin. – Kenton Henry
****************************************************
Feature Article
The Texas Tribune
Wednesday, September 18, 2013
Perry Directs TDI to Regulate Federal Navigator Program
Gov. Rick Perry has directed the Texas Department of Insurance to establish strict rules to regulate so-called navigators trained to help Texans purchase health coverage under Obamacare.
While the governor says the extra regulations will ensure that people handling Texans’ private financial and health information are properly trained and qualified, the rules could present a significant roadblock to organizations helping to implement the federal Affordable Care Act.
“This is blatant attempt to add cumbersome requirements to the navigator program and deter groups from working to inform Americans about their new health insurance options and help them enroll in coverage,” Fabien Levy, a spokesman for the U.S. Department of Health and Human Services, said in an email.
Along with many other provisions in President Obama’s signature health reform law, the individual mandate to purchase health insurance is set to take effect on Jan. 1. Texas’ Republican majority, which vehemently opposes the federal health law, declined to establish a state-based insurance marketplace. The federal government is doing it instead, launching an Orbitz-like online insurance exchange starting Oct. 1. That exchange will require individuals to input sensitive tax information, including their Social Security numbers and estimated annual income, to determine whether they qualify for tax credits to purchase coverage.
To help uninsured Texans use the complicated new system, the federal government awarded nearly $11 million in August to local organizations charged with hiring and training navigators, who will help consumers input their financial information and pick a health plan through in the exchange, must undergo 20 to 30 hours of training, pass a certification test and renew their certification annually, according to the U.S. Department of Health and Human Services.
For Perry, those ground rules are not enough.
“The U.S. Department of Health and Human Services has repeatedly delayed explaining how its navigators were going to be created, how they were going to operate and how they were going to be regulated,” Perry wrote in a letter to Insurance Commissioner Julia Rathgeber. “Because of the nature of navigators’ work and because they will be collecting confidential information, including birth dates, social security numbers and financial information, it is imperative that Texas train navigators on the collection and security of such data.”
In the letter, Perry specifically directed TDI to establish rules that require navigators to complete at minimum of 40 hours of state training in addition to the federal training requirements. He also demanded that navigators pass a rigorous exam based on that training, refrain from influencing a consumer’s insurance choice by recommending a specific plan or comparing benefits offered by different plans, and submit to periodic background and regulatory checks and show state identification while on the job.
He also directed TDI to maintain a database of registered navigators, including background checks and fingerprints; set limits on when and where navigators can enroll people in the exchange; charge fees to provide navigator training and registration; and establish the department’s authority to suspend or revoke navigators’ registration for failing to comply with state requirements.
“TDI agrees that the navigators in Texas have to be well trained and competent in what they’re doing,” said Ben Gonzalez, an agency spokesman. “Our goal is for them to be accountable and be conscientious about the confidential information that they’re going to be collecting.”
Federal officials said some of the rules Perry ordered the state insurance department to implement are forbidden under U.S. law. For example, navigators are not allowed to retain or report information on consumers who sign up for coverage through the exchange; therefore, they could not submit that information to TDI, as Perry has requested. The federal agency also emphasized that navigators are not allowed to access consumers’ information after it has been submitted to the exchange.
Levy said the U.S. government has similar programs already set up to help counsel people applying for Medicare, and that those have “never faced this kind of bullying from Texas.”
“This is clearly an ideologically-driven attempt to prevent the uninsured from gaining health coverage,” Levy said. “But despite the state’s attempts, we are confident that navigators will still be able to help Texans enroll in quality, affordable health coverage when open enrollment begins on Oct. 1.”
Given the governor’s directive, the department will begin putting together the rules with some urgency, Gonzalez added. The rule-making process can take several weeks, as the state is required to hold public meetings and solicit stakeholder input before the rules are drafted. After a draft is approved, the rules must be posted on the Texas Register to receive official comment before they can be codified.
“It’s our expectation the rules and training be in place by Jan. 1, when insurance can be purchased through the exchange,” Rich Parsons, a spokesman for the governor’s office, said via email.
The federal health exchange has a six-month open enrollment period — from Oct. 1 to March 31 — in which navigators can help the uninsured find health coverage to comply with the insurance mandate. Individuals who do not purchase insurance during the open enrollment period could be subject to federal tax penalties. If the state’s regulations take effect on Jan. 1, the navigators will be required to undergo additional training during the open enrollment period, which could present significant challenges.
To address the privacy concerns raised about the navigator program, some grant recipients are already requiring navigators to undergo additional training on privacy protection. United Way of Tarrant County, in collaboration with 17 other organizations, received $5.8 million, the largest federal navigator grant in Texas. Tim McKinney, the organization’s chief executive officer, said the organization is requiring navigators to undergo an additional hour-and-a-half of training on how to comply with the federal privacy law HIPAA.
Lawmakers signed off on Perry’s call for greater regulation of the navigator program in the last legislative session when they passed Senate Bill 1795, which authorizes TDI “to regulate navigators if it determined that federal standards did not ensure they were qualified to perform their duties or avoid conflicts of interest,” according to a legislative report. The new state law allows the department to enact rules that protect patient privacy and prohibit navigators from accepting payments from health insurance companies or posing as an insurance agent. At least 16 other states have also enacted or are considering laws to regulate navigators, according to a USA Today report.
Texas Attorney General Greg Abbott and 12 other state attorneys general have also raised concerns that the federal navigator program could pose risks to patients’ privacy. In a letter sent to U.S. Health and Human Services Secretary Kathleen Sebelius in August, the attorneys general asserted that the federal government’s screening process does not require uniform background or fingerprint checks, meaning convicted criminals or identity thieves could become navigators. They also expressed concerns that navigators would not undergo sufficient training.
Some medical professionals and advocates have objected to the privacy concerns raised by conservatives, suggesting they are politically motivated. For example, navigators must already comply with state and federal laws governing the privacy of sensitive medical information. If they do not adhere to strict security and privacy standards, including how to handle and safeguard consumers’ Social Security numbers and identifiable information, they are subject to criminal and civil penalties at both the federal and state level. The federal government imposes up to a $25,000 civil penalty for violating its privacy and security standards.
This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

http://allplaninsurance.com

Navigator Vs. Insurance Broker: Who To Go To For Your New Affordable Care Act Health Insurance?

By Kenton Henry, Administrator

 
Let me preface this article with an admission. I am a health insurance broker and have been for 27 years. So consider that as you weigh the comparison suggested in the title of this piece.

 
Very shortly (October 1 to be exact) you are going to be able to enroll in a new Affordable Care Act (ACA) compliant health insurance plan to be effective January 1. Having health insurance at that time is no longer an option – it is a mandate. You probably know this by now and there is no need to review the details and I will not be addressing the penalties for not having coverage next year and beyond. Rather, I will be addressing your options for enrolling and factors you might want to weigh before electing the path you take to enrollment. I will strive to be as objective as possible in light of my preface.

 
First, let’s consider going through an insurance agent or broker like myself. Before I could consider selling my first health insurance policy back in 1986, I had to study for and pass my state’s insurance exam in order to obtain my license. I did this initially in Indiana and again in 1991 when I moved to Texas. While not the Bar Exam or Medical Board Exams – on both occasions they were comprehensive tests and I recall spending weeks of self-study in the quiet of the local library for the first and–after 5 years of experience–another week and a 40 hour prep course to boot for the second. They covered my knowledge of things not the benefit of common sense–and they were certainly not IQ tests–but measured my grasp of esoteric insurance laws, regulations, the principles and components of insurance and ethics among other topics. Next, I had to be appointed with an insurance company before I could represent their products. In addition to an application, an appointment entailed a thorough background and credit check. Approximately twenty years ago, every company with whom I applied to for an appointment made it mandatory I purchase errors and omissions coverage just as required of your attorney or doctor. Every person is fallible and the insurance makes certain an agent’s clients can be compensated for any negligence or unintentional mistake on the agent’s part resulting in the client’s harm. Fortunately, I have never had to file a claim with my E & O company nor have I had a complaint filed against me with a state insurance commission. I must also undergo and complete a minimum of 30 hours of continuing education every 24 months in order to keep my license. A record of this is made the State Insurance Commissioner. My license binds me to the same rules and regulations regarding my client’s privacy, confidentiality and personal information as the aforementioned professionals with whom you share the same type of information. Any compromise in it could result in revocation of my license not to mention civil liability on my part.

 
Who pays for these tests, licenses, continuing education and insurance? I do. It comes out of my personal income. Not to mention the cost of all my supplies, office overhead and gas utilized in seeing my clients at their convenience. Oh yeah . . . and I pay for my own health insurance. And I have never minded these expenses. These are merely the costs of doing business and I was happy to pay them when compared to the alternative which would have required being someone’s employee. So these are pretty much the facts as to my professional background, what is required of me and the protection afforded you by such.

 
Before contrasting this with the alternative – consider:
“The 2010 (ACA) law is intended to prod millions of Americans to buy health insurance, many for the first time. Those seeking coverage must provide details on citizenship, family size and income to determine whether they’re eligible for subsidies, and complete a form that can stretch to seven pages.” – Bloomberg 08.23.13

 
And the alternative to licensed agent or broker? As of October 1st, you will also have the option of going through a “Navigator” hired by your state and whose compensation will be subsidized with federal funds. (Clue: federal funds is code for your tax dollars). The Navigator’s job is to be educate you as to your options and help you elect one before being turned over to an enroller, otherwise known as a customer service representative. The latter will make this happen mechanically and it will most likely be accomplished by you going to a link and completing an electronic enrollment form estimated to be up to 21 pages or greater in length. (We don’t know yet. They and the premiums for coverage are yet to be released.)

 
While the requirements will vary from state to state, the federal requirements for Navigators are 20 hours of training. The federal health insurance exchange will apply in Texas, Indiana and Ohio. These are three of four states where I am licensed. There will be no background checks involved in the hiring process for Navigators as we are told there is no time for such. The administration says “we need to get as many people as possible to sign up as quickly as possible.” The Navigators will not be licensed. They will not pay for errors and omissions insurance. You will pay for their supplies, their insurance and their benefits.

 
I certainly don’t have to be your agent but these are factors you might want to consider before seeking assistance in enrolling in your new health insurance plan. If you feel I have unfairly or otherwise misrepresented things, please feel free to comment as much. In the feature articles below, some opposing or off-setting opinions are expressed–mostly by administration officials.

 

 

Admin. – Kenton Henry

 
************************************
Coming Articles: Biggest Traps of the Affordable Care Act for Medicare Recipients
************************************

 
Feature Articles:

 
BLOOMBERG August 23, 2013

 
State Laws Hinder Obamacare Effort to Enroll Uninsured
By Alex Nussbaum & Alex Wayne – Aug 23, 2013 2:32 PM CT

 
New laws passed by a dozen Republican-led states, the latest in Missouri last month, may make that harder, imposing licensing exams, fines that can run as high as $1,000 and training that almost doubles the hours required by the federal government. Republicans say the measures will protect consumers. Obamacare supporters say they’ll undermine the effort to get as many people as possible enrolled.
The rules are “like voter intimidation,” said Sara Rosenbaum, a health law professor at George Washington University in Washington, D.C., who supports Obama’s act. “In many, many cases these laws may be a direct interference with outreach assistance and that’s going to be quite serious.”
The Obama administration awarded 105 grants last week, steering money to hospitals, social-service agencies, local clinics and other groups. The navigators are meant to offer “unbiased information” to help people through the complexities of the new system, with its deductibles, copays, provider networks and tax credits, according to an Aug. 15 statement from the U.S. Department of Health and Human Services.
October Deadline
The grants were issued barely a month before the online exchanges are scheduled to open for enrollment on Oct. 1. The administration has said about 7 million people may enroll next year and it needs to motivate millions of young, healthy customers to sign up to keep the markets financially stable.
The state laws may complicate that task. The restrictions go farthest in a handful of states like Georgia and Missouri, where Republican legislators have already refused to set up the new insurance websites or spend money to promote the law.
In Florida this week, Governor Rick Scott told a Miami audience that federal privacy protections for consumers working with navigators were “behind schedule and inadequate.” He urged people to use brokers and agents instead.
Georgia Governor Nathan Deal, a Republican, believes navigators need state regulation because they’ll give advice on “a highly complicated and highly important topic,” his spokesman, Brian Robinson, said in an e-mail. They will also handle personal information that is open to abuse.
Consumer Protection
“This is a consumer protection issue more than anything,” said Kenneth Statz, an insurance broker on the legislative council of the National Association of Health Underwriters, a Washington-based group representing agents and brokers. “We just want to make sure that somebody who is sitting down with a consumer, trying to help them make this major decision, is going to be properly prepared.”
The state laws have passed with the backing of insurance agents and brokers, who view the online exchanges as competition and navigators as potential rivals with an unfair advantage absent new rules.
States require agents to be licensed and undergo periodic training, said Statz, who’s based in Brecksville, Ohio. He also has to carry insurance to protect clients who may be hurt by bad advice or malpractice, he said.
The 2010 law is intended to prod millions of Americans to buy health insurance, many for the first time. Those seeking coverage must provide details on citizenship, family size and income to determine whether they’re eligible for subsidies, and complete a form that can stretch to seven pages.
Federal Requirements:
While states controlled by Democrats such as Maryland, New York, Minnesota and Illinois have also passed rules, these generally follow federal requirements, said Mark Dorley, a health-policy researcher at George Washington University.
Other states have been more restrictive.
Georgia’s navigators need a license from the insurance commissioner. Each person assisting the uninsured has to pay a $50 application fee, complete 35 hours of training — 15 more than the federal requirement — pass an exam, and complete a criminal background check. Licenses must be renewed every year, requiring another $50 and 15 more hours of training.
Missouri defines navigators more broadly than the federal government, said Andrea Routh, executive director of the Missouri Health Advocacy Alliance in Jefferson City. Violating certification requirements risks a $1,000 fine.
Seeking License
Routh’s group, which seeks to educate people on the health law, didn’t apply for a grant. It may seek a license just to be safe, she said.
“Anyone who does outreach and education, or anybody who assists anyone with enrollment had better be checking that law to see if they need to be licensed,” she said.
Missouri voters approved a ballot initiative last year barring Governor Jay Nixon, a Democrat, from setting up the exchange without the assent of the Republican-controlled legislature, which has declined to act so far.
The rules may scare off churches, clinics or others who want to help, said Cindy Zeldin, executive director of Georgians for a Healthy Future. The Atlanta-based nonprofit was part of a group that won a $2.1 million grant.
Georgia’s law implies “navigators are somehow problematic,” she said in a telephone interview, “rather than that they’re groups that likely have a history of working in communities and are trusted.”
‘In Conversations’
The Obama administration has been “in conversations with states” to ensure their laws don’t hinder the effort, said Chiquita Brooks-Lasure, a deputy director at the federal health department, in an Aug. 15 conference call with reporters.
The federal law doesn’t require background checks, though navigators must provide quarterly reports and can lose their grants in cases of fraud or abuse. The administration is requiring them to undergo an initial 20 hours of training.
Some people opposed to Obama’s overhaul “want to see it fail,” said Missouri Health’s Routh. “If you put a lot of barriers in place that make it tough for nonprofits to go out and educate people and assist them in understanding the exchange, that may be one way to have it fail.”
******************************
The Washington Post
Health and Science
States scramble to get health-care law’s insurance marketplaces up and running
By Sarah Kliff and Sandhya Somashekhar, Published: August 24
With a key deadline approaching, state officials across the country are scrambling to get the Affordable Care Act’s complex computer systems up and running, reviewing contingency plans and, in some places, preparing for delays.
Oct. 1 is the scheduled launch date for the health-care law’s insurance marketplaces — online sites where uninsured people will be able to shop for coverage, sometimes using a government subsidy to purchase a plan. An estimated 7 million people are expected to use these portals to purchase health coverage in 2014.
The task is unprecedented in its complexity, requiring state and federal data systems to transmit reams of information between one another. Some officials in charge of setting up the systems say that the tight deadlines have forced them to take shortcuts when it comes to testing and that some of the bells and whistles will not be ready.
“There’s a certain level of panic about how much needs to be accomplished but a general sense that the bare minimum to get the system functional will be done,” said Matt Salo, executive director of the National Association of Medicaid Directors. “It will by no means be as smooth and as seamless as people expected.”
Oregon announced this month that it will delay consumers’ direct access to its marketplace, opening the Web site only to brokers and consumer-assistance agents in order to shield consumers from opening-day glitches.
“Even though we’re testing now, once you actually have the system up, you don’t know what the bugs will be,” said Amy Fauver, spokeswoman for Cover Oregon, the state agency implementing the law there.
In California, which has the nation’s largest uninsured population, health officials have begun hinting that they may have a similar problem.
“It’s a complex system, and there’s a lot of navigation that needs to happen,” said Oscar Hidalgo, a spokesman for Covered California. He said the agency will know by early September whether the system will be ready in time.
If not, he said, customers will still be able to log on to the Web site and peruse insurance plans and view prices. When they get to the final step, however, they will not be able to sign up. They will have to contact a customer service representative to complete the final enrollment step.
Officials with the District of Columbia’s Health Link decided to put off building a Spanish version of its Web site until later this year, giving its staff bandwidth to complete other tasks they see more critical to the launch.
Until then, the District will have bilingual call-center workers and in-person helpers who will be able to help Spanish speakers navigate the site.
The hiccups are troubling to advocates, who worry that there will be mistakes that result in people being erroneously rejected by Medicaid or denied subsidies to which they are entitled. They are concerned that impediments will discourage the uninsured from signing up for coverage.
“There will be something up and running, but there will be serious, serious difficulties with it” that could result in delays and errors initially, said Robert H. Bonthius Jr., a lawyer at the Legal Aid Society of Cleveland. “It’s an extremely ambitious program, well-intentioned, that is going to be very difficult to accomplish, and it’s going to be months and maybe years before it really gets sorted out.”
With a key deadline approaching, state officials across the country are scrambling to get the Affordable Care Act’s complex computer systems up and running, reviewing contingency plans and, in some places, preparing for delays.
Oct. 1 is the scheduled launch date for the health-care law’s insurance marketplaces — online sites where uninsured people will be able to shop for coverage, sometimes using a government subsidy to purchase a plan. An estimated 7 million people are expected to use these portals to purchase health coverage in 2014.
See how the states have sided on some of the key provisions of the Affordable Care Act:
The task is unprecedented in its complexity, requiring state and federal data systems to transmit reams of information between one another. Some officials in charge of setting up the systems say that the tight deadlines have forced them to take shortcuts when it comes to testing and that some of the bells and whistles will not be ready.
“There’s a certain level of panic about how much needs to be accomplished but a general sense that the bare minimum to get the system functional will be done,” said Matt Salo, executive director of the National Association of Medicaid Directors. “It will by no means be as smooth and as seamless as people expected.”
Oregon announced this month that it will delay consumers’ direct access to its marketplace, opening the Web site only to brokers and consumer-assistance agents in order to shield consumers from opening-day glitches.
“Even though we’re testing now, once you actually have the system up, you don’t know what the bugs will be,” said Amy Fauver, spokeswoman for Cover Oregon, the state agency implementing the law there.
In California, which has the nation’s largest uninsured population, health officials have begun hinting that they may have a similar problem.
“It’s a complex system, and there’s a lot of navigation that needs to happen,” said Oscar Hidalgo, a spokesman for Covered California. He said the agency will know by early September whether the system will be ready in time.
If not, he said, customers will still be able to log on to the Web site and peruse insurance plans and view prices. When they get to the final step, however, they will not be able to sign up. They will have to contact a customer service representative to complete the final enrollment step.
Officials with the District of Columbia’s Health Link decided to put off building a Spanish version of its Web site until later this year, giving its staff bandwidth to complete other tasks they see more critical to the launch.
Until then, the District will have bilingual call-center workers and in-person helpers who will be able to help Spanish speakers navigate the site.
The hiccups are troubling to advocates, who worry that there will be mistakes that result in people being erroneously rejected by Medicaid or denied subsidies to which they are entitled. They are concerned that impediments will discourage the uninsured from signing up for coverage.
“There will be something up and running, but there will be serious, serious difficulties with it” that could result in delays and errors initially, said Robert H. Bonthius Jr., a lawyer at the Legal Aid Society of Cleveland. “It’s an extremely ambitious program, well-intentioned, that is going to be very difficult to accomplish, and it’s going to be months and maybe years before it really gets sorted out.”
******************************************************************************

http://allplanhealthinsurance.com

The Chameleon Which Is The Affordable Care Act

08.14.2013

The Affordable Care Act, like a chameleon, is capable of changing its color or otherwise morphing to fit the pragmatic motives of its creator.

As I have said before, the Patient Protection Affordable Care Act (PPACA) (or ACA for short) is law. Therefore, of late, I have attempted to focus on the reality of it and its ramifications for all of us whether we are currently uninsured, covered by our employer’s plan or have our own individual or family health insurance plan. The primary purpose of this blog is to educate and inform– not to editorialize. If the latter were my objective, I would establish a separate blog where I would rant and rave ad infinitum about all I see wrong with the Act and big government in general. But it is not, so writing for The MedPlus Messenger, I try to remain objective and minimize expression of my feelings. But it is difficult. Increasingly so. Each day I try to put more lipstick on this pig but each day I awaken to more news the White House has selectively chosen another segment of the ACA not to implement in 2014 pursuant to the law.
Yesterday’s headlines broke news that the caps on insured’s out-of-pocket (OOP) maximums–set to go in effect in 2014–have been delayed until 2015. This potentially doubles (or worse) the liability of an insured and benefits the insurance company by allowing it to avoid covering expenses above the current OOP’s. Do you believe that is the objective of the White House? To benefit the insurance companies? And I thought the whole reason for the ACA was to better protect the patient, consumer, insured member. After all, it is the Patient Protection … … … Act is it not?
So what was the motive behind the White House’s reprieve for insurance companies? “General Math” provides the answer. I.e.:
Lower patient out-of-pockets = higher insurance premiums
Higher insurance premiums = less participation in coverage and greater backlash against the ACA

 

Greater backlash = trouble for the Democrats in the 2014 mid-term elections
Conclusion = this reprieve was politically motivated

 

Reader and followers – if you can argue this to a different conclusion – please feel free to do so here for my erudition and that of the rest of us.

 
Admin – Kenton Henry
*******************************************************************
Feature Articles:
Washington Times
By Tom Howell Jr.
Tuesday, August 13, 2013
President Obama has granted yet another part of his health care law a delay, quietly announcing a one-year grace period before imposing a strict limit on consumers’ out-of-pocket medical expenses.
The delay means some health care plans in the group market will have until 2015 to begin paying for all expenses exceeding $6,350 for an individual’s out-of-pocket spending, or $12,700 for a family.
________________________________________
SPECIAL COVERAGE: Health Care Reform
________________________________________
Language on the delay has been posted on the Labor Department’s website since February, but it did not surface in the political arena until The New York Times reported on it Tuesday.
Mr. Obama used the limits as a key selling point when he pushed the Affordable Care Act through Congress in 2010. Now, Republicans are using the delay as part of last-ditch bids to dismantle the law before key implementation dates this fall.
“Burying this announcement online in a ‘maze of legal and bureaucratic language’ shows little concern for the promises with which this law was sold,” said House Speaker John A. Boehner, Ohio Republican, borrowing language from the Times article. “What else in the law isn’t working that we don’t yet know about?”
The Obama administration also announced in a pre-July Fourth blog posting that it was delaying the mandate that requires employers with at least 50 full-time employees to provide them with health care coverage.
For the Obama administration, the setbacks are ill-timed and leave officials trying to convince consumers that the delays don’t signal an inability to carry out other parts of the law.
Erin Shields Britt, spokeswoman for the Department of Health and Human Services, said the health care law is still implementing historic consumer protections from “the worst insurance company abuses, by banning discrimination based on pre-existing health conditions, ending lifetime and annual limits on what an insurance company will cover, and capping out-of pocket spending to protect Americans and their families.”
“The February guidance builds on these landmark consumer protections by requiring that health plans limit out-of-pocket spending for major medical coverage for the first time, in 2014, on time,” she said. “This single limit will apply to additional benefits in 2015.”
The newly reported delay arose because some employers and insurers use separate companies to administer major-medical coverage and drug benefits, resulting in separate out-of-pocket limits.
Because of this fractured landscape, parties needed time to streamline their data systems . The rule says that, for the first plan year after Jan. 1, 2014, the annual limit on out-of-pocket expenses will be satisfied if a group health plan that uses more than one service provider complies with the cap on major medical coverage and maintains a similar cap on the non-major medical coverage.
Even as it delays some parts, the administration has said the individual mandate requiring most Americans to have coverage remains in effect. Officials also are working feverishly to implement by Oct. 1 state-by-state health care exchanges where those without employer-based coverage can buy insurance with the help of tax credits.
A recent inspector general report suggested that Health and Human Services is months behind in setting up the federal data hub that will allow federal and state agencies to synchronize information about consumers on the exchanges.
Senate Minority Leader Mitch McConnell, Kentucky Republican, wrote to the Obama administration Monday to suggest that it delay the rollout of the exchanges.
Conservative lawmakers are waging a rhetorical war against Obamacare ahead of a spending showdown on Capitol Hill in September.

**************************************

Forbes

Pharma & Healthcare |

8/13/2013

Yet Another White House Obamacare Delay: Out-Of-Pocket Caps Waived Until 2015

WASHINGTON, DC – MARCH 18: U.S. President Barack Obama (L) speaks as Assistant Attorney General of Justice Department’s civil rights division Thomas Perez (R) listens during a personnel announcement March 18, 2013 at the East Room of the White House in Washington, DC. Perez has succeeded Hilda Solis as the U.S. Secretary of Labor. (Image credit: Getty Images via @daylife)

First, there was the delay of Obamacare’s Medicare cuts until after the election. Then there was the delay of the law’s employer mandate. Then there was the announcement, buried in the Federal Register, that the administration would delay enforcement of a number of key eligibility requirements for the law’s health insurance subsidies, relying on the “honor system” instead. Now comes word that another costly provision of the health law—its caps on out-of-pocket insurance costs—will be delayed for one more year.

According to the Congressional Research Service, as of November 2011, the Obama administration had missed as many as one-third of the deadlines, specified by law, under the Affordable Care Act. Here are the details on the latest one.

Obamacare contains a blizzard of mandates and regulations that will make health insurance more costly. One of the most significant is its caps on out-of-pocket insurance costs, such as co-pays and deductibles. Section 2707(b) of the Public Health Service Act, as added by Obamacare, requires that “a group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish lifetime limits on the dollar value of benefits for the any participant or beneficiary.” Annual limits on cost-sharing are specified by Section 1302(c) of the Affordable Care Act; in addition, starting in 2014, deductibles are limited to $2,000 per year for individual plans, and $4,000 per year for family plans.

Move up http://i.forbesimg.com t Move down

Obamacare Increases Costs of College Health Plans by as Much as 1,112% Avik Roy Contributor

There’s no such thing as a free lunch. If you ban lifetime limits, and mandate lower deductibles, and cap out-of-pocket costs, premiums have to go up to reflect these changes. And unlike a lot of the “rate shock” problems we’ve been discussing, these limits apply not only to individually-purchased health insurance, but also to employer-sponsored coverage. (Self-insured employers are exempted.)

These mandates have already had drastic effects on a number of colleges and universities, which offer inexpensive, defined-cap plans to their healthy, youthful students. Premiums at Lenoir-Rhyne University in Hickory, N.C., for example, rose from $245 per student in 2011-2012 to between $2,507 in 2012-2013. The University of Puget Sound paid $165 per student in 2011-2012; their rates rose to between $1,500 and $2,000 for 2012-2013. Other schools have been forced to drop coverage because they could no longer afford it.

According to the law, the limits on out-of-pocket costs for 2014 were $6,350 for individual policies and $12,700 for family ones. But in February, the Department of Labor published a little-noticed rule delaying the cap until 2015. The delay was described yesterday by Robert Pear in the New York Times.

Delay needed to align ‘separate computer systems’

Notes Pear, “Under the [one-year delay], many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.”

The reason for the delay? “Federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another.”

The best part in Pear’s story is when a “senior administration official” said that “we had to balance the interests of consumers with the concerns of health plan sponsors and carriers…They asked for more time to comply.” Exactly how is it in consumers’ interests to pay far more for health insurance than they do already?

It’s not. Unless you have a serious, chronic condition, in which case you may benefit from the fact that law forces healthy people to subsidize your care. To progressives, this is the holy grail. But for economically rational individuals, it’s yet another reason to drop out of the insurance market altogether. For economically rational businesses, it’s a reason to self-insure, in order to get out from under these costly mandates.                         Patient groups upset

While insurers and premium-payers will be happy with the delay—whose legal justification is dubious once again—there are groups that grumbled. Specifically, groups representing those with chronic diseases, and the pharmaceutical companies whose costly drugs they will use. “The American Cancer Society American Cancer Society shares the concern” about the delay, says Pear, “and noted that some new cancer drugs cost $100,000 a year or more.” But a big part of the reason those drugs cost so much is because manufacturers know that government-run insurers will pay up.

“The promise of out-of-pocket limits was one of the main reasons we supported health reform,” says Theodore M. Thompson of the National Multiple Sclerosis Society National Multiple Sclerosis Society. “We have wonderful new drugs, the biologics, to treat rheumatoid arthritis,” said Patience H. White of the Arthritis Foundation. “But they are extremely expensive.”

The progressive solution to expensive problems? More subsidies. But subsidies don’t reduce the underlying cost of care. They only excuse the high prices that manufacturers and service providers already charge.

It’s one of the many aspects of Obamacare that should be repealed, if we are to combat the rate shock that the health law imposes on tens of millions of Americans. But that will require Republicans to come up with a smarter strategy than shutting down the government.

***************************************************************************************************

http://allplaninsurance.com

What is Coming with Your Health Insurance Between Now and January 1!

Just Practical Information On What is Coming with Your Health Insurance Between Now and January 1!

08.12.2013
This is not an editorial. Today’s post is simply non-political, practical information regarding coming changes in health insurance between now and 2016 and beyond. The Patient Protection and Affordable Care Act (PPACA) is law and is on schedule to be fully implemented (for all but groups of 50+) January 1, 2014. For this reason it is my responsibility to inform my clients – and followers of this blog – of what they can expect in the coming months. Specifically, their insurance options and the mechanics involved in transitioning to health plans that provide minimum “essential benefits” that are in compliance with the PPACA. In this post, I will be addressing individuals and families which includes the self-employed and those who have a personal policy because their employer does not provide coverage. All others, including those covered by group plans for less than 50 employees will be addressed in subsequent posts.
First – those of you who currently have a personal or family policy will be allowed to keep your policy until your policy anniversary in 2014. You should check your anniversary date or–if you are my client–call me. Many companies have changed your anniversary date to December 1. This allows you to keep your current plan until December 1, 2014. After that, you must convert to a health care “compliant” plan which will be described below. I can simplify and assist you in this process when the time comes.
If you do not currently have health insurance you must purchase a health policy to be effective January 1 or pay a penalty on your tax return for 2014 and beyond. Another reason you may want to purchase a plan is if you have previously been unable to acquire a policy which covers your pre-existing health condition(s). Your new compliant plan must cover them and health issues will not factor into your cost.
When October 1 arrives (the earliest date you may apply for compliant coverage) I will provide you a link where you will enter your estimated income for 2014. It will instantly tell you whether you qualify for a subsidy. If you do – you are going to want to choose from and apply for plan options in your state health insurance exchange. If your state has not established a state exchange (as is the case in Texas) – you will select from plans in the Federal Health Insurance Exchange. If you do not qualify for a subsidy (which is the case if your income is 400% or greater than the Federal Poverty Level*) – you are probably going to choose a policy offered outside an exchange and direct from an insurance company. The reason being, it is anticipated these plans will offer the same benefits at a lower cost. I can assist you with this option as well.
Below, I will offer further and detailed information on exchanges, plan options and more. Please do not hesitate to call me for clarification or to discuss this information.

Admin. – Kenton Henry

*
FEDERAL POVERTY LEVEL GUIDELINES 2013

http://allplanhealthinsurance.com

*************************************
STEP 1:
Note these key dates and deadlines in your calendar:
If your employer offers health insurance, get key dates from your HR department. These are key dates if you’re planning to buy health care through your state’s Marketplace, which is available through a web site, a call, or an in-person visit.
• Oct. 1, 2013: First day you can enroll in a health plan on your state’s Marketplace
• Dec. 31, 2013: Last day you can enroll in a health plan and have your coverage start Jan. 1, 2014
• Jan. 1, 2014: First day you have insurance coverage if you buy a plan in the Marketplace — if, of course, you buy before this date
• March 31, 2014: The last date you can enroll in a plan on your state’s Marketplace to be covered for part of 2014
*************************************
Requirements:
* Be a citizen or legal resident.
• Buy your coverage through your state’s or Federal new health insurance Marketplace, also called an “Exchange”.
• Make about $11,490 to $45,960 a year if you are single – or $23,550 to $94,200 a year if you are in a family of four.
If you make less than the lowest amount, you may be eligible for Medicaid. Medicaid will cost you less than you’d save with a tax credit.
Unfortunately, if your state is not expanding Medicaid based on the guidelines in the Affordable Care Act, you may not be able to enroll in Medicaid or be able to get a tax credit. It’s possible that if you make less than $11,490 in 2013, which is the poverty level, you may not qualify for Medicaid if you live in a state that isn’t expanding Medicaid.
In general, you’re not eligible for the tax credits if you could get coverage through a workplace. However, the coverage offered by your employer must be considered affordable. If your company offers a plan that costs more than 9.5% of your income, or that does not cover at least 60% of the cost of covered benefits, you can look for a more affordable plan through your state’s Marketplace and may receive tax credits to lower your costs.
********************************
Insurance Exchanges
State Didn’t Set Up a Marketplace? Relax
You may have heard that not all states will have their own health insurance Marketplace, also called an Exchange. If your state doesn’t set up a Marketplace, what does that mean for you?
Rest assured that no matter which state you live in, you can buy insurance through a Marketplace starting October 2013.
The way you use the Marketplace will be similar in every state. You’ll access a web site, or call, or see someone in person. And you’ll have tools to compare health plans.
But Marketplaces won’t all be the same in every state. There are three ways your state’s Marketplace can be managed — and this affects your choice of health plans and coverage.
1) State-run Marketplaces
Seventeen states are creating their own Marketplaces. These states will have a lot of local control.
Each state will decide which insurance companies can sell policies on its Marketplace.
States also choose the core benefits each plan has to offer. They can set extra requirements for health plans, like benefits that are more generous or more affordable limits on your out-of-pocket costs.
The state is also in charge of getting people to use the Marketplace.
*Indiana and Ohio will have their own State Exchange. Residents of these states should call Kenton Henry @ 800.856.6556
2) Partnerships Between a State and the Government
A few states are teaming up with the federal government to develop Marketplaces.
The federal government:
• Sets up the Marketplace web site and in-person sites
• Decides which health plans will be sold in the partner state
• Sets the benefit levels
• Runs the Marketplace
The states:
• Monitor health plans
• Help people find the best insurance for their needs *(Call Kenton Henry @ 800.856.6556)
• Handle complaints
Federal-run Marketplaces
Some states decided not to set up their own Marketplaces. In those states, the federal government will step in to run the marketplaces directly. It will make all the decisions: how the Marketplace will work, what plans are sold, and how to promote the Marketplace. Each state is considered separately and has its own Marketplace web site. (Texas residents call Kenton Henry @ 800.856.6556)
**********************************************
Your Insurance Choices in a Marketplace: FAQ

A health insuranceMarketplace, also known as an Exchange, is a one-stop shop for affordable insurance in your state. Your state’s Marketplace has tools to make it easy for you to compare your choices and pick the best for your needs.
On a state Marketplace site, health plans are grouped by levels of coverage — how much the plan will pay for your health care and what services are covered.
Each level is named after a type of metal:
• Bronze
• Silver
• Gold
• Platinum
Bronze plans offer the least coverage and platinum plans offer the most.
How do the bronze, silver, gold, and platinum levels differ?
The metal plans vary by the percentage of costs you have to pay on average toward the health care you receive.
Here are the percentages of health care costs you pay for each type of plan:
• Bronze plan: 40%
• Silver plan: 30%
• Gold plan: 20%
• Platinum plan: 10% of your health care costs.
The way you pay your portion of these costs is in deductibles and copayments or co-insurance.
In general, the more you are willing and able to pay each time for health care service or a prescription, the lower your premium. A premium is your monthly payment to have insurance.
As an example, when you compare the bronze and platinum plans:
With a bronze plan: You pay the most each time you see your doctor or get a medicine. This is also called having higher “out-of-pocket” costs. But in a bronze plan you pay the least premium each month.
With a platinum plan: You pay the least each time you see your doctor or get a medicine. But in a platinum plan you pay the highest premium each month.
How does coverage from a metal plan compare to my current insurance?
The bronze through platinum coverage levels are new. So you probably don’t know how the benefits of the plan you use today compare to them. The coverage level you have now depends on whether you bought your plan:
• From an employer: Your coverage level is likely between a gold and platinum level.
• On your own: Your coverage level is likely between a bronze and silver level.
Having a sense of how the insurance you’re used to compares with the new plans will help you decide on a plan. You should compare the out-of pocket costs you are currently paying, the services provided (including prescription drugs), and anticipated changes in your health.
If you shop for insurance on your state’s Marketplace, you’ll see the health plans organized in this way:
• 1st by metal level: Bronze, silver, gold, or platinum
• 2nd by brand, such as Blue Cross, Cigna, Humana, Kaiser, United, and others
• 3rd by type of health plan, such as HMO, PPO, POS, or high-deductible plans with a health savings account.
The type of health plan affects how much choice you have in providers, the amount of paperwork you have, and your out-of-pocket costs.
**************************************
Tax Penalty At-a-Glance: Who Will Pay The Penalty & How Much Is It?
By law, you need to have health insurance by 2014. If you already get insurance through your employer or your partner’s employer, you’re all set. But what happens if you don’t follow this requirement from the Affordable Care Act?
If you can afford health insurance and don’t buy it, you’ll pay a fine when you file your 2013 income taxes in April 2014.
For the first year of the new law, 2014, the fine for not having insurance is the lowest it will be. After that, it goes up steeply in 2015 and again in 2016.
In 2014: There are two ways the government calculates what you owe. You have to pay whichever amount is higher.
• One way is to charge you $95 for each adult and $47.50 for each child, but not more than $285 total per family.
• The other way is to fine you 1% of your family income. If your family makes $50,000 a year, the fine will be $500.
In 2015: There will still be two ways to calculate what you owe. You have to pay whichever amount is higher.
• One way is to charge you $325 for each adult and $162.50 for each child, but no more than $975 total per family.
• The other way is 2% of your family income. If your family makes $50,000 a year, the fine will be $1,000.
In 2016 and beyond: There will still be two ways to calculate what you owe. You have to pay whichever amount is higher.
• One way is to charge you $695 for each adult and $347.50 for each child, but no more than $2,085 per family.
• The other calculation is 2.5% of your family income. If your family makes $50,000 a year, the fine will be $1,250.

http://allplanhealthinsurance.com

Polls Clearly Indicate the Affordable Care Act Losing Popularity

07.30.2013

Polls clearly indicate that the Patient Protection and Affordable Care Act is losing popularity with not only Democrats and Republican politicians but the American public in general. In spite of the fact that no real costs of the Affordable Care Act to employers have been realized (other than those spent in attempts to decipher it through paid consultants or in house benefits directors and actuaries) popularity for the law continues to diminish. Much of this disenchantment could stem from the fact that more of us are realizing we really may lose our current health coverage and–perhaps more importantly–our providers. Others realize part-time employment may become the norm as employers attempt to avoid the mandate they provide health insurance to full time employees, i.e., those working 30 or more hours per week. It is a highly unpopular mandate with labor unions which have always supported a minimum 40 hour work week as the definition of full-time employment. It seems only logical many employers will restrict workers to less than 30 hours in attempt to avoid providing health insurance coverage. Another unintended consequence of government’s attempts to improve things.

Admin. – Kenton Henry

******************************

Featured Articles (Reprints June 30th and 26th Editions of the National Association of Health Underwriter’s Washington Update)

Is Health Reform Losing Its Base?

It is no secret that public support for health reform has always been mixed at best and that many Republicans have strongly disliked this law from the start. Now it seems like moderate Democrats are joining the pessimistic about health reform crowd. A recent poll conducted by the Washington Post and ABC News showed that moderate Democrats (who were previous PPACA supporters) are becoming lukewarm about the health reform law. When the law was initially passed in 2011, 74% of moderate and conservative Democrats were in favor of the law. Now, that number is down to 46%. Even more notable is that support is 11 points lower than what it was last year at this time. Liberal Democrats on the other hand still strongly support the law, with 78% of them still loving it to be exact. Among the public at large, 42% support and 49% oppose the law, retreating from an even split at 47% last July. On average, 56% of Democrats now support the law, according to the poll, down 10% from last year.
The same day these polling results were released, President Obama gave a speech out of Knox, Illinois on the economy. While the focus of the speech was the nation’s economy, President Obama unsurprisingly, given the magnitude of its economic impact, brought up the health reform law and tried again to raise support. This time, the president noted that the law is in fact working in the states that embrace it. Many of the states that have decided to fight the law are not seeing as many positive results. He cited states such as California and New York as proof that the law is driving costs down. The president also said that we are “well on our way” to full implementation of the law and that once implemented, the law’s benefits will provide security to middle class families.

*****************************

Legislation and Policy

Republicans Divided Over Threat To Defund ACA.
Many outlets, mostly out of the beltway, focus on the political machinations surrounding funding for the Affordable Care Act. The reports highlight a growing rift among factions of the Republican party: those who are pushing to defund the law using a spending bill, and those who believe the move, which could ultimately result in a government shutdown, would be politically dangerous.
Roll Call (7/30, Dennis, Fuller, Subscription Publication) reports that “with 60 Republicans already pushing…to defund Obamacare in any spending bill,” Speaker John Boehner “may not be able to cobble together a House majority” to stave off a government shutdown without courting Democrats. The article notes, though, that “several prominent Republicans” have spoken out against the effort, as this threat “would surely backfire on Republicans if they carry it out.”
FOX News (7/30) reports on the “divide” in the GOP, saying that the “aggressive” push to defund the Affordable Care Act is “increasingly pitting Republicans against Republicans.”
Indeed, several Republicans have spoken out against defunding the law. Politico (7/30, Arkin) reports that in an appearance on MSNBC Monday, House Deputy Whip Tom Cole (R-OK) warned that “shutting down the government to defund Obamacare is a ‘suicidal political tactic.’” Cole is quoted as saying, “Shutting down the government is a suicidal political tactic. Eventually it will be reopened, but the president will not have capitulated and you will have discredited yourself and along the way you will have hurt the American people.”
The Washington Examiner (7/30, Carroll) reports on another high profile Republican who is against defunding the Affordable Care Act, Oklahoma Senator Tom Coburn, who called the efforts “dishonest” and “hype.”
Also reporting on Republican opposition to the tactic are MSNBC (7/30, MacDonald) and the Tulsa (OK) World (7/30, Greene).
However, many Republicans are still pushing for the tactic, led Monday by Texas Senator Ted Cruz. Politico (7/30, Kopan) reports that in an interview with Glenn Beck Monday, Cruz argued that Republicans have the opportunity to can defund the ACA, but “‘scared’ Republicans are standing in the way.” Cruz said, “What I can tell you is there are a lot of Republicans in Washington who are scared. They’re scared of being beaten up politically.”
The Washington Examiner (7/30, Spiering) reports that Senator Marco Rubio (R-FL) “defended” the proposal, saying, “With all these problems why would anyone want to continue with this failed experiment? Only in Washington do people double down on their mistakes.”
Other outlets reporting on Republicans who support fighting for defunding the ACA include the Huffington Post (7/30, Schlanger), the NBC News (7/30, Hunt) website, the Deseret (UT) News (7/30, Askar), The Hill (7/30, Baker) “Healthwatch” blog, The Hill (7/30, Jaffe) “Ballot Box” blog, and the Washington Examiner (7/30, Spiering).
As one of the few Democrats inserting himself into the intra-GOP rift, Politico (7/30, Everett) reports that on Monday, Senate Majority Leader Harry Reid said, “If Republicans force us to the brink of another government shutdown for ideological reasons, the economy will suffer. I would suggest to any of my Republican colleagues that has this idea: Give a call to Newt Gingrich. … Ask him how it worked. It was disastrous for Newt Gingrich, the Republicans and the country.”
Commentary Considers GOP Rift Over Defunding ACA. In addition to accounts of the Republican rift over defunding the Affordable Care Act, several outlets carry analyses and opinion pieces reacting to the debate. Despite some maintaining sympathies for the Republican cause, all conclude that the tactic is certain to fail at the least, and potentially dangerous for the party at the most.
Well-known conservative blogger Jennifer Rubin, in her Washington Post (7/30) “Right Turn” blog, quotes various Republican leaders who are speaking out against the tactic, including Senator Richard Burr (R-NC), who called it “the dumbest idea I’ve ever heard.” Rubin concludes that it is a “certainty” that “the GOP is not going to defund Obamacare on its namesake’s watch.”
Sean Sullivan, in his Washington Post (7/30, Sullivan) “The Fix” blog, calls Cruz’s decision to call his GOP colleagues “scared” for not going along with his plan “a perilous move.” While he is confirming his “conservative bona fides,” Sullivan writes, Cruz is also highlighting his “willingness to be an antagonist at virtually every turn.”
Brent Budowsky, in a piece for The Hill (7/30) “Pundits Blog,” writes that as many Republicans agree, “threatening to shut the government down over healthcare is profoundly unwise policy for America and profoundly unwise politics for the GOP.”
Avik Roy offers a lengthy analysis of the tactic in his Forbes (7/30) “Apothecary” blog, saying that a one year delay of the ACA’s central provisions may be better than a complete repeal.
On the MSNBC (7/30) website, Geoffrey Cowley criticizes Senator Marco Rubio (R-FL) for doubling down on the “kill-it-at-all-costs rhetoric,” seeking to blame President Obama for a potential government shutdown.
Dennis Byrne, a Chicago writer, calls the plan “more than stupid,” in the Chicago Tribune (7/30). He argues that the tactic “will surely fail,” and could very well “cost the GOP in the 2014 elections, possibly including control of the House.” The only way to repeal the law, he concludes, is to “turn the spotlight on what they’d replace it with.”
Similarly, in an editorial, the Baton Rouge (LA) Advocate (7/30) criticizes Republicans for continuing to oppose the Affordable Care Act without coming up with a viable alternative. The paper argues that any sort of GOP-sanctioned replacement “requires legislative initiative, not just opposition.”
Syndicated columnist Jules Witcover writes in the Baltimore Sun (7/30) that despite continued unpopularity, the Affordable Care Act “will nevertheless prevail.”
House To Vote This Week To Repeal Part Of ACA For 40th Time.
The Hill (7/30, Baker) “Healthwatch” blog reports that this week, the House will vote “for the 40th time to repeal part of ObamaCare.” The bill, sponsored by Representative Tom Price (R-GA), restricts the IRS from implementing any part of the law. The article points out that this is part of the GOP’s “effort to keep up the negative pressure” following the employer mandate delay.
Republicans Seek To Change ACA’s Definition Of Full-Time Employment.
CQ (7/30, Attias, Subscription Publication) reports on the “ongoing debate” over whether Congress should revise the Affordable Care Act’s definition of full time employment. So far, “Republicans and business representatives” have voiced their support for “an effort to change the definition to 40 hours a week,” but Democrats aren’t behind it.
The Delmarva (MD) Daily Times (7/30, Gaudiano) also reports on the effort to change the full-time employment threshold.
ACA Call Center Under Fire For Not Offering Health Benefits To All Workers.
FOX News (7/30) reports that a call center set up to offer Affordable Care Act assistance in Contra Costa, California, is making news for not offering health insurance to all of its employees. The state’s budget “only allows for half of the customer service agents hired to work full-time,” which many in the community find “disappointing.”
Feds’ Marketing Of ACA To Young People May Violate Age Discrimination Act.
The Daily Caller (7/29, Howley) reports that the Obama Administration’s public relations campaign touting “the benefits of enrolling in Obamacare” to young people “appears to violate the federal Age Discrimination Act,” which “states that no program that receives federal money can discriminate with respect to age.” The Daily Caller notes that the “campaign-style demographic targeting” would “at least initially have the discriminatory effect of not equally promoting subsidized health care to older participants whose participation would not be as favorable for Obamacare’s convoluted apparatus.”


http://allplanhealthinsurance.com