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
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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.
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SPECIAL COVERAGE: Health Care Reform
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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.

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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.

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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

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FEDERAL POVERTY LEVEL GUIDELINES 2013
http://allplanhealthinsurance.com
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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
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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.
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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)
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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.
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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

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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.

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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

No Joke! – IRS Employee’s Union Wants No Part of ACA Exchange Coverage

07.26.2013

No Joke! – IRS Employee’s Union Wants No Part of ACA Exchange Coverage
Op Ed:
In an ultimate case of hypocrisy (which would be hysterical were it not foretelling a travesty of monumental proportions about to be inflicted on the American people) the Union of IRS employees wants no part of the Obamacare and the Affordable Care Act (ACA)! The Union urges its members to write their congressmen expressing reservation about being forced out the Federal Health Benefits Program and into the insurance exchanges scheduled to be up and functional by October 1. The Federal Health Benefits Program is the “Cadillac” health plan we have always heard federal employees enjoy at our expense. In the meantime, many of us will be forced to give up our current health insurance and providers to acquire what they dictate is right for us. The very representatives who passed and will enforce the legislation and mandates say it is good enough for you and me while not wanting to accept it for themselves. They want no part of the very thing they are forcing down our throats!
We cannot make this up people! And you’re not outraged? Or are you?
(For more details, please see our first feature article below.)

Admin. – Kenton Henry
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FEATURE ARTICLES:
Washington Examiner
IRS employee union: We don’t want Obamacare
BY JOEL GEHRKE | JULY 26, 2013 AT 11:45 AM
TOPICS: ANALYSIS BELTWAY CONFIDENTIAL

National Taxpayer Employee Union officials are giving members a form letter expressing concern…
IRS employees have a prominent role in Obamacare, but their union wants no part of the law.
National Treasury Employees Union officials are urging members to write their congressional representatives in opposition to receiving coverage through President Obama’s health care law.
The union leaders are providing members with a form letter to send to the congressmen that says “I am very concerned about legislation that has been introduced by Congressman Dave Camp to push federal employees out of the Federal Employees Health Benefits Program and into the insurance exchanges established under the Affordable Care Act.”
The NTEU represents 150,000 federal employees overall, including most of the nearly 100,000 IRS workers.
Like most other federal workers, IRS employees currently get their health insurance through the Federal Employees Health Benefits Program, which also covers members of Congress.
House Ways and Means Committee Chairman Dave Camp offered the bill in response to reports of congressional negotiations that would exempt lawmakers and their staff from Obamacare.
“Camp has long believed every American ought to be exempt from the law, which is why he supports full repeal,” Camp spokeswoman Allie Walkersaid.
“If the Obamacare exchanges are good enough for the hardworking Americans and small businesses the law claims to help, then they should be good enough for the president, vice president, Congress and federal employees,” she also said.
“The NTEU represents Internal Revenue Service employees who have the responsibility to enforce much of the health insurance law, especially in terms of collecting the taxes and distributing subsidies that finance the whole system,” said Paul Kersey, director of Labor Policy at the Illinois Policy Institute.
“IRS agents will also collect data and apply penalties for those who fail to comply with many of Obamacare’s requirements,” Kersey said.
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Polls Identify Americans’ Disapproval Of ACA.
In continuing coverage, the Washington Times (7/26, Sherfinski) “Inside Politics” blog reports on a Fox News poll which shows that 53% of respondents would choose to repeal the Affordable Care Act, given the choice between keeping the law in entirety or overhauling it. The piece also reports on a separate poll, from CBS News, which found that “fifty-four percent disapprove of the law and 36 percent approve of it.”
The National Journal (7/26, Shepard, Subscription Publication) reports on the findings from the new United Technologies/National Journal Congressional Connection Poll which found that “opponents of President Obama’s health care law overwhelmingly believe the Affordable Care Act will worsen the quality of their care.” Further, more of the law’s supporters than not “don’t think it will improve their health care.”
Klein Extols Opportunities Brought By ACA. Washington Post blogger and MSNBC political analyst Ezra Klein writes about the coming “opportunity to change American health-care forever,” in a piece for Bloomberg News (7/26). He explains that the Affordable Care Act “carries the potential for both huge profits and huge social benefits,” as long as “Washington can stop bickering over the politics long enough to pay attention.”
Wonkblog Explores Former Republican Alternative To ACA. The Washington Post (7/26, Matthews) “Wonkblog” reports on a former Republican plan to “replace” the Affordable Care Act, proposed in 2009 by Sen. Tom Coburn (R-OK) and Rep. Paul Ryan (R-WI). Known as the Patients’ Choice Act, the law was “a credible way of covering almost all Americans,” picking up 13 co-sponsors in the House and seven in the Senate. After describing the central aspects of the bill, pointing out its similarities with the ACA.
Papers Offer Opposite Opinions On Repealing ACA. In an editorial, the Colorado Springs (CO) Gazette (7/26) encourages Republicans to work to defund the Affordable Care Act, because “most Americans don’t want” it. The paper argues that “perhaps nothing would give our country’s economy a greater jump-start than” stopping the law “in its tracks.”
However, in an opposing editorial, the Ogden (UT) Standard-Examiner (7/26) asks Congress to “respect” the Affordable Care Act. Although the paper has “problems” with the law, it argues that implementation “should not be hijacked through the inappropriate use of a filibuster, or the House refusing to vote for its funding.”

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Christie Slams ACA At GOP Governors’ Meeting.
The Newark (NJ) Star-Ledger (7/26, Portnoy) reports that in a discussion with fellow Republican Governors in Aspen, Chris Christie of New Jersey on Thursday called the Affordable Care Act a “sad legacy” for President Barack Obama. During the talk, Christie said that while he has expanded Medicaid under the law, “he twice vetoed health exchanges.” Criticizing the law, Christie said, “This is what happens when you use Parliamentary maneuvers to jam an absolute sea change in American life down the throats of the American people with bare majorities and not one Republican vote.”
Jindal, Walker Say ACA Is Not Workable. In an op-ed for the Wall Street Journal (7/26, Jindal, Subscription Publication), Louisiana Gov. Bobby Jindal and Wisconsin Gov. Scott Walker write that the ACA is not workable and predict chaos as the Oct. 1 deadline for health insurance exchanges to launch. The Governors argue that while delaying implementation off the ACA is a good idea, outright repeal of the law would be better.
New Jersey Policy Analyst Discusses ACA Benefits. NJ Today (7/26) carries video of an interview with New Jersey Policy Perspective Senior Policy Analyst Raymond Castro, who discusses the benefits of the Affordable Care Act to “New Jersey residents and business owners.” In the interview, Castro drew attention to the law’s subsidies, available to those purchasing insurance on the state’s exchange, calling them “the most important part of the reform.” Castro also pointed out that New Jersey stands to “save a lot of money” under the ACA, as the Federal government will take over a large chunk of costs.
Panels Answer ACA Questions In Utah And Alabama. The Salt Lake (UT) Tribune (7/26) reports that on Thursday, a “panel of Utah health care advocates, experts and state policy leaders answered questions” about the Affordable Care Act in “a televised town hall” event. The article links to recorded versions of the event.
Alabama Live (7/26, Berry) reports that the Chamber of Commerce of Huntsville/Madison County held a panel Thursday morning to inform “several dozen professionals” how the Affordable Care Act “will impact their small businesses in Madison County.” Led by Small Business Administration Alabama District Director Tom Todt, the Affordable Care Act 101 seminar “featured an overview of the Small Business Health Care Tax Credit, Small Business Health Options Program (SHOP) and Employer Shared Responsibility for Employee Health Coverage.”

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White Castle Considering Upping Part-Time Hires Due To ACA.
The Huffington Post (7/26) reports that in response to the Affordable Care Act’s employer mandate, White Castle “is considering hiring only part-time workers in the future,” its Vice President Jamie Richardson said in an interview Thursday. Richardson insisted, though, that “the restaurant chain has no intention of firing members of its current full-time staff or reducing benefits.”
The Los Angeles Times (7/26, Lopez) reports that in an interview with NPR Wednesday, Richardson further outlined his plan to deal with ACA implementation, saying, “As we look to the future, when the new healthcare law takes effect, we are considering at that point, for new hires, letting those people know upfront, ‘Hey, at this point we’re only able to hire part-time team members.’”
Brooks-LaSure Speaks At Senate Hearing On ACA. Bloomberg BusinessWeek (7/26, Clark) reports on Wednesday’s Senate Committee on Small Business and Entrepreneurship hearing on concerns about the Affordable Care Act. According to the article, “the big questions…didn’t have easy answers.” Will, when asked whether “all health exchanges will be up and running as scheduled on Oct. 1,” HHS Deputy Director Chiquita Brooks-LaSure “said she expects all exchanges will be up and running.”
Survey: Business Owners In New England More Optimistic About ACA. The Boston Globe (7/26, Reidy) reports that a new survey out of Deloitte LLP shows that “mid-size companies in New England seem to be more optimistic about containing health care costs than their national counterparts.” Overall, 60% of executives “cited rising health care costs as a major obstacle to US growth,” while only 46% did in New England.

http://allplaninsurance.com

House to Vote on Affordable Care Act Individual and Employer Mandates

07.17.2013

Currently we have over 800,000 veterans awaiting decisions on their disability claims. The back log is so great–according to the most recent numbers available–the average wait time for a veteran is 15 months in Chicago, 16 months in New York and a year and a half in Los Angeles. Social Security’s disability program, which helps support 11 million Americans, will run through its trust fund in 2016, two years earlier than predicted. Couple this with the prediction Social Security, the fund that finances benefits for 44 million senior citizens and their survivors, will be exhausted by 2035 and Medicare, the health care program for those age 65 and over, will be have depleted its funds by 2024. Now consider a law has been passed which mandates health coverage for every American. Its objectives are largely, and initially, funded via subsidies from the federal government (you the tax payer). Can you possibly believe this is feasible given their track record? Given a federal debt of almost 17 trillion dollars? How long do you believe it will take before all private insurance companies are forced to withdraw from participation to be replaced by a single payer federally administrated program which can’t possibly be any more financially feasible than our government’s disability program, Social Security or Medicare?

Admin. – Kenton Henry

http://allplanhealthinsurance.com

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Today’s Feature Articles:

Legislation and Policy

House Votes To Target ACA Individual, Employer Mandates.

Coverage of the Obama Administration’s decision to delay the Affordable Care Act’s employer mandate continues Wednesday, the same day the House is set to vote to further capitalize on the weak position they believe the move has put Democrats in. Most reports, some national in scope, focus on the House votes to delay both the employer and individual mandates, while others focus on the implications of both of these provisions.

McClatchy                          (7/17, Kumar) reports that on Wednesday, the Republican-ruled House is expected to vote to delay key parts of the Affordable Care Act, a move that “is the latest in a sweeping legislative and political campaign to weaken the 2010 law and raise even more opposition in the eyes of an already skeptical nation, especially as it heads into 2014 elections that will decide control of the Congress and set the stage for the 2016 campaign for the White House.” The back-to-back votes will determine “whether to delay insurance mandates for both employers and individuals.”

The Washington Times

(7/16, Howell) reports that “President Obama has threatened to veto” the bills. Meanwhile, “the votes will force Democrats to align with the president or distance themselves from the overhaul in the wake of its recent stumbles.” In addition, it has put the “Office of Management and Budget in the awkward position of threatening, in the case of the employer mandate, to kill a bill that would reflect the White House’s own decision-making.”

CNN

(7/16, Walsh) reports that “most House Democrats are expected to oppose two House Republican bills on Wednesday that would delay key provisions of Obamacare,” according to House Democratic Whip Steny Hoyer (D-MD).

The Hill

(7/17, Baker) “Healthwatch” blog reports that the bill to delay the individual mandate “would cut the deficit, but would cause insurance premiums to rise,” according to the Congressional Budget Office.

Implications Of Employer Mandate Delay Still Unclear. The AP

(7/17, Alonso-Zaldivar) reports on the “domino effect” that is currently “undercutting” the Affordable Care Act: the Obama Administration’s delaying of the law’s employer mandate could “weaken” the individual mandate, because the requirement that companies report health insurance details for employers has also been pushed back. As the article explains, “without employers validating who’s covered, a scofflaw could lie, and the government would have no easy way to check.” The piece calls this yet “another incentive for uninsured people to ignore a new government requirement that for many will cost hundreds of dollars.”

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Not All Insurers Game for State Exchanges: The Consumer Impact

By Kate Rogers

Published July 11, 2013

FOXBusiness

As more insurers decide to pack up and leave certain states as health exchanges start to take form, experts say consumers are going to be left  feeling the pain.

Over the last few weeks, several departure announcements have sent a ripple through the health insurance industry, as companies weigh whether or not they want to play ball under Obamacare. So far, California has experienced the biggest migration  with Aetna (AET), UnitedHealthcare (UNH) and Cigna (CI) leaving the state’s exchange, Covered California.

Aetna also reportedly sent out a note to select customers last week, warning that the Patient Protection and Affordable Care Act is “changing health insurance.” Recipients were customers across the country with non-grandfathered health plans, meaning their plan was not in effect on March 23, 2010 and wouldn’t carry over under new state and federal exchange regulations under ACA.

“This includes adding preventative care and essential health benefits. The ACA also ends medical underwriting. Due to these and other changes, many people will pay more for their health insurance coverage in 2014 than they do today,” the letter stated according to the carrier.

Wellmark Blue Cross/Blue Shield also decided not to list on the individual exchange in Iowa for 2014, due to a lack of information available in the state, according to a spokesperson for the Iowa Insurance Division.

Fifteen states and the District of Colombia are in the process of creating their insurance exchanges before the 2014 deadline; when individuals must purchase insurance or face a fine for failing for comply with the individual mandate. The employer mandate has been pushed back to 2015, and some in the GOP including House Majority Leader Eric Cantor, (R-VA), are calling for the individual mandate to be rolled back as well.

More or Less Competition for Consumers?

Some experts say the recent departures hint consumers will have limited health-insurance choices thanks to the regulatory burdens of the law. Basic supply and demand dictates that with fewer insurers to choose from, consumers will have limited options and potentially higher prices, says Michael Cannon, director of Health Policy Studies at the CATO Institute.

A similar “exodus” occurred within the first six months of the implementation of the Affordable Care Act, Cannon says, when child-only care was enacted. Seventeen major insurers dropped child-only coverage, in an attempt to skirt the law’s new regulations and increased costs. The same may begin to take shape in the individual market.

“The program says you can’t charge higher premiums to the sick, so you have a situation where only low-risk consumers would be charged a premium much higher than their regular costs, so only people who buy it would be those who really needed it,” he says.

The employer mandate rollback is also a factor in the situation, says Grace-Marie Turner, founder of the Galen Institute, a health and tax policy research organization, as employers will now be incentivized to drop coverage and push their employees into the exchanges until 2015.

“It’s using employers to push more people into the exchanges,” Turner says.

Fewer insurers in state exchanges mean less competition, bottom line, she adds. “The whole point is we want more players, and more competition.”

Why California Matters

What happens in California is a big deal for the future of the Affordable Care Act, says Taylor Burke, associate professor and program director, MPH in Health Policy, at George Washington University.

“It’s an exit out the individual market, but [the insurers] only represent 8% of the individual market companies in the state,” Burke says. “California has the 7th largest economy on the globe, so whatever happens in California is a big deal for the stand up of the state exchanges.”

He points to two main reasons insurers leave a state: they don’t like the price points being offered in the exchanges nor the coverage they would have to offer under Obamacare’s 10 essential health benefits.

“In California, you can make the argument that there would be less choice, but if they stay in the market, their prices would be off the charts,” he says. “It would be a thing on the shelf, a high-ticket item that you couldn’t afford anyway.”

And if insurers take too long to make the decision, that may impact them negatively as well, he says.

“No one will want to buy their product. There’s a lot of hemming and hawing, but if the price point is too high, no one will buy it.”

But can consumers blame the insurer for higher prices? Turner says no, it’s the nature of the law’s regulations.

“Insurers can’t help the demands on the benefits they will have to cover—it will absolutely be more expensive,” she says. “It’s like going to buy a car with every accessory in the books—heated seats, fancy wheels, satellite radio, and saying you can’t charge more for it.”

What Insurers are Deciding

Robert Zirkenbach, spokesman for America’s Health Insurance Plans (AHIP), says each individual company will have to make their own decisions about which states to participate in as exchange bids come in.

“It will be based on a variety of reasons, but plans are offering coverage on the exchange, some will be outside the exchange—there will be options for consumers,” Zirkenbach says. “It will depend on the state and regulatory environment.”

He says the AHIP wants competition among insurers to keep consumer prices in check.  “Choice and competition is a good thing—when states have been setting up their exchanges, we are trying to encourage this,” he says.

The National Association of Insurance Commissioners says insurers who are leaving these markets are likely doing so because they have core businesses in other segments, including the large group market.

“The carriers we have seen exiting the individual market are not major players in that market segment, and therefore we don’t anticipate a major disruption of coverage for a large portion of the market,” a spokesperson said in an email statement. “Each insurance company is making decisions regarding its participation in exchanges based upon a number of factors.  Some are opting to participate in the exchanges, while others are not; however, nearly all of the requirements that apply to policies sold on the exchange also apply to policies sold outside the exchange, so insurers will not be avoiding a lot of requirements by opting out of the exchanges.”

Welcome to The MedPlus Messenger Blog!

THE MEDPLUS MESSENGER

VOL I, ISSUE 1, 16 JULY 2013

THE MEDPLUS MESSENGER blog is for the dissemination and discussion of information regarding health, Medicare and life insurance legislation; laws; trends; products and related topics. It is intended to be of use to the general public; clients and prospective clients of ALL PLAN MED & LIFE QUOTE the parent company of ALLPLANINSURANCE.COM: http://allplaninsurance.com; ALLPLANHEALTHINSURANCE.COM; ALLPLANINTERNATIONALHEALTHINSURANCE.COM and IndianaHealthInsurance4U.com.

ADDRESSING: HEALTH AND MEDICARE RELATED INSURANCE ISSUES INCLUDING THE AFFORDABLE CARE ACT (ACA); COMPLIANCE WITH THE AFFORDABLE CARE ACT; STATE AND FEDERAL HEALTH INSURANCE EXCHANGES; CURRENT BEST VALUES IN HEALTH INSURANCE; IMPACT OF THE ACA ON EMPLOYERS; DECLINATION DUE TO PRE-EXISTING CONDITIONS; MEDICARE AND MEDICARE RELATED INSURANCE (MEDIGAP); PART D PRESCRIPTION DRUG PLANS

While The MedPlus Messenger has existed for sometime as an industry and marketing newsletter–today is the first time we have existed and published as a blog. The reasons for this are numerous but the greater ones are: the tremendous amount of confusion, on the part of the public, regarding the ACA and its implementation; the diverse opinions and perspectives on it; apprehension as to its effects on the quality of health care; the cost of insuring for medical expense and the options for doing so available to employer groups, individuals and families and Medicare recipients. Only through intelligent discourse of these topics can our subscribers transition through implementation into optimal utilization of health care, as well as protection against the cost for such, with as little inconvenience as possible. Only by discussing your concerns, , perspective, frustrations and opinion can Allplanhealthinsurance.com better meet your needs in this rapidly changing marketplace. Already the availability of health insurance has become an entitlement by law and its issue and administration may well be on the brink of falling within the exclusive confines of another federal program. For these reasons, not only are your insights and questions welcomed but your disagreements and protests encouraged as well.    

OUR MISSION:

It has and will remain the goal of Allplaninsurance.com to provide the most objective health, Medicare related, life and dental insurance quotes–along with the very best of service to the our policyholders. We serve residents of all fifty states (US) and the international community. We see it as our responsibility to monitor the state of the national and international insurance and the political process as it relates to such. It is our objective and, we feel–our duty–to inform the public of such matters. ALL PLAN MED & LIFE QUOTE has been based in The Woodlands, Texas since 1991.

THE MEDPLUS MESSENGER is not copyrighted and articles and analysis presented in THE MEDPLUS MESSENGER may be reproduced at your discretion. However, articles and analysis should not be construed as representing the policy, endorsement or opinion of ALL PLAN MED & LIFE QUOTE, or its agents, unless so stated. Although carefully verified, data are not guaranteed as to accuracy or completeness. ALL PLAN MED & LIFE QUOTE cannot be held directly responsible for any direct or incidental loss incurred by applying any of the information in this publication.

DIRECT QUESTIONS OR SUGGESTIONS TO FIELD OFFICES:

TEXAS & ALL OTHERS: 800.856.6556; quote@allplaninsurance.com

CALIFORNIA: 800.200.5278; insurnet@snowcrest.net

NEW YORK: 888.766.6932; sonny@onestopinsuranceshopping.com

IMPORTANT PHONE NUMBERS AND LINKS:

THE AFFORDABLE CARE ACT, SECTION BY SECTION (U.S. Department of Health and Human Services Website): http://www.hhs.gov/healthcare/rights/law/index.html

CENTERS FOR MEDICARE & MEDICAID SERVICES: 1.800.633.4227: http://www.medicare.gov

U. S. (Federal) Pre-Existing Condition Health Insurance Plan:  https://www.pcip.gov/

The United States Senate: http://www.senate.gov/general/contact_information/senators_cfm.cfm

Texas Department of Insurance: 800.252.3439: http://www.tdi.state.tx.us/

Texas Health Insurance Risk Pool (for those uninsurable by private health insurance):

888.398.3927; TDD 1.800.735.2989: http://txhealthpool.com/

New York Department of Insurance: 800.342.3736: http://www.ins.state.ny.us/

Illinois Department of Insurance: 217.782.4515: http://www.idfpr.com/

Indiana Department of Insurance: 317.232.2410: http://www.state.in.us/idoi/

California Department of Insurance: 916.322.3555: http://www.insurance.ca.gov/

United States Treasury Health Savings Account Guidelines:  http://www.treasury.gov/

Doctor Comparison:  http://www.bcbstx.com/bluecompare/tour/index.html

National Association of Health Insurance Underwriters:  http://www.nahu.org/

VISIT OUR WEB SITES AT:

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TODAY’S ISSUE OF DISCUSSION:

The Affordable Care Act (ACA) and its current state of implementation; the impact of such on health insurance premiums and the delayed Employer Mandate.

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FEATURE ARTICLES:

Op-Ed:

The ensuing articles demonstrate that efforts to implement the Affordable Care Act remain behind schedule and the mechanisms in place to ensure such were never for this herculean task. It is logical to conclude this is, in large part, due to the burden of  comprehending the content and demands of two thousand plus pages of the act itself and nine thousand plus pages of accompanying regulations. Both the public and private sector responsible for implementation are obviously overwhelmed with massive work this requires. This, along with the greatly underestimated costs of implementation and regulation, does not bode well for a smooth and efficient transition into compliance. Even less assured is  the long term solvency of the ever-decreasing number of participating health plans or the feasibility of guaranteed health care.

Due to the minimal penalties for failing to purchase health insurance during the next two years, it is predicated participation by those currently choosing to be uninsured will be negligible. When compared to the cost of insuring which is predicted to increase in many cases by as much or more than 100%–it is reasonable to conclude most will simply choose to pay the penalty. This will disprove the assumption that a huge influx of young, healthy insured members will subsidize the cost of insuring the older, and generally less healthy, individuals which the was the main premise on which feasibility arguments were based.

We can see from recent legislative action that portions of the bill which would impede implementation have been suspended. This, at worst, appears politically motivated and, at best, an effort to make certain as many as possible sign up for individual and family coverage through an exchange. Whether or not you are in favor of the latter is probably dependent on whether you would like to see a “single payer” health insurance system in place as, I feel, this will be the ultimate result of the exchanges and their plan mandates. In the meantime, The ACA is law. Suspension of portions of a passed act inconvenient to implementation of the act itself is unprecedented to my knowledge and there appears no legal basis for doing so.

The featured articles below begin with an overview of the distinction between “Minimum Essential Coverage” and “Essential Health Benefits” and conclude with recent abatements in enforcement of certain portions of the law. That these abatements, suspensions, moratoriums are convenient is unquestionable. The question remains, “for whom?”

Kenton Henry

Administrator, Editor: The MedPlan Messenger

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OVERVIEW MINIMAL REQUIRED COVERAGE AND PENALTIES FOR NON-COMPLIANCE

Beginning in 2014, the Affordable Care Act includes a mandate for most individuals to have health insurance or potentially pay a penalty for noncompliance. Individuals will be required to maintain minimum essential coverage for themselves and their dependents. Some individuals will be exempt from the mandate or the penalty, while others may be given financial assistance to help them pay for the cost of health insurance.

What type of coverage satisfies the individual mandate?

“Minimum essential coverage”

What is minimum essential coverage?

Minimum essential coverage is defined as:

  • Coverage under certain      government-sponsored plans
  • Employer-sponsored      plans, with respect to any employee
  • Plans in the individual      market,
  • Grandfathered health      plans; and
  • Any other health      benefits coverage, such as a state health benefits risk pool, as      recognized by the HHS Secretary.

Minimum essential coverage does not include health insurance coverage consisting of excepted benefits, such as dental-only coverage.

How does “Minimum Essential Coverage” differ from “Essential Health Benefits”?

Essential health benefits are required to be offered by certain plans starting in 2014 as a component of the essential health benefit package.  They are also the benefits that are subject to the annual and lifetime dollar limit requirements.

This is different than minimum essential coverage, which refers to the coverage needed to avoid the individual mandate penalty.  Coverage does not have to include essential benefits to be minimum essential coverage.

What is the penalty for noncompliance?

The penalty is the greater of:

  • For 2014, $95 per      uninsured person or 1 percent of household income over the filing      threshold – whichever is greater
  • For 2015, $325 per      uninsured person or 2 percent of household income over the filing      threshold – whichever is greater
  • For 2016 and beyond,      $695 per uninsured person or 2.5 percent of household income over the      filing threshold –whichever is      greater

There is a family cap on the flat dollar amount (but not the percentage of income test) of 300 percent, and the overall penalty is capped at the national average premium of a bronze level plan purchases through an exchange.  For individuals under 18 years old, the applicable per person penalty is one-half of the amounts listed above.

Beginning in 2017, the penalties will be increased by the cost-of-living adjustment.

Who will be exempt from the mandate?

Individuals who have a religious exemption, those not lawfully present in the United States, and incarcerated individuals are exempt from the minimum essential coverage requirement.

Are there other exceptions to when the penalty may apply?

Yes.  A penalty will not be assessed on individuals who:

  1. cannot afford coverage      based on formulas contained in the law,
  2. have income below the      federal income tax filing threshold,
  3. are members of Indian      tribes,
  4. were uninsured for      short coverage gaps of less than three months;
  5. have received a      hardship waiver from the Secretary, or are residing outside of the United      States, or are bona fide residents of any possession of the United States.

*Further Clarification of the Applicable penalty
The individual one-time penalty under ACA in 2014 will be $95 per adult, or one percent of your income, whichever is greater. So say your annual income is $50,000, you’d pay $500. For every uninsured child, the penalty is $47.50. The family maximum is $285.
Coverage is assessed on a monthly basis, So if you were uninsured for six months, you’d owe half the otherwise applicable penalty.”
She said that the government has given a wide window – from Oct. 1, 2013 to March 31, 2014 – for enrollment this time, but from next year on there will only be a three-month window to sign up.
Will people take the gamble and skip coverage, hoping that their youth or good health will protect them?
If the state of Massachusetts, which passed a landmark health care law in 2006, which became the blueprint for the 2010 ACA, is any indication the number of people who will refuse to get some form of coverage will be low.
In Massachusetts, “there’s a culture of coverage. Most people want to comply with the law.”

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FORBES

Pharma & Healthcare |

7/06/2013 @ 6:25PM |290,284 views

Not Qualified For Obamacare’s Subsidies? Just Lie — Govt. To Use ‘Honor System’ Without Verifying Your Eligibility

If you thought the delay in the employer mandate was bad news for Obamacare, just wait. On Friday, Sarah Kliff and Sandhya Somashekhar of the Washington Post discovered that the Obama administration had buried in the Federal Register the announcement that the government won’t be able to verify whether or not applicants for Obamacare’s insurance exchange subsidies are actually qualified for the aid, in the 16 states that are setting up their own exchanges. Instead, until at least 2015, these states will be able to “accept the applicant’s attestation [regarding eligibility] without further verification.”

Without employer mandate, Feds to rely on applicant ‘attestations’

If you’ve been following the latest news around Obamacare, you know that on Tuesday evening, just before the Independence Day holiday, the White House announced that it would be delaying the implementation of the health law’s employer mandate—requiring all firms with more than 50 employees to provide health coverage to their workers—until 2015.

I, and several others at the time, said “wait a minute.” According to the law, you aren’t eligible for Obamacare’s subsidies if your employer has offered you what the government considers “affordable” coverage. But if employers are no longer going to report whether or not they’ve offered “affordable” coverage, how can the government verify whether or not workers are eligible for subsidies?

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DELAYED EMPLOYER MANDATE THE LATEST CHANGE FOR INCREASINGLY UNSTEADY HEALTH-CARE LAW

July 4, 2013 | Washington Post

The Obama administration has postponed one of the fundamental provisions of the health-care reform law, responding to mounting concerns from business owners who would have been required to start providing health coverage to their employees next year. On Tuesday evening, Treasury Department officials announced the government would not penalize businesses that fail to provide health insurance next year, delaying what is known as the “employer mandate” component of the law until 2015. Starting then, firms with more than 50 employees will be required to provide at least a minimum level coverage to their workers or pay a steep fine to the federal government. Officials made the decision to push the requirement back after fielding a flood of complaints from business owners about its implementation. “We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively,” Mark Mazur, assistant secretary for tax policy, wrote in a blog post announcing the postponement, later adding that the administration plans to use the additional time to “consider ways to simplify the new reporting requirements” for business owners. The newly delayed mandate has been a major point of contention for small business owners and lobbyists since it was approved as part of the Affordable Care Act in 2010. Many warned that it would cause administrative nightmares for small employers and discourage those near the cutline from expanding beyond 50 workers. Meanwhile, some firms have started scaling back their payrolls to get underneath the cap. “Small companies have told us they are confused by the law and are simply finding it difficult to comply with, no matter when it goes into effect,” Rep. Sam Graves, chairman of the House Small Business Committee, said in an email to The Washington Post. “Instead of providing relief for businesses, this simply kicks the can down the road.” A White House official said the added time would help small business owners adapt to the changes, arguing that the law will still drive down prices for coverage on Main Street. “This allows employers the time to .?.?. make any necessary adaptations to their health benefits while staying the course toward making health coverage more affordable and accessible for their workers,” Valerie Jarrett, an adviser to Obama, wrote in a blog post on Tuesday. This latest delay is the most consequential in a series of setbacks for the president’s signature law, which has shown signs of fragility as the initial deadline for full implementation approaches at the end of the year. In April, the administration announced it would delay for one year a key cost-cutting feature of the law’s new small business health insurance marketplaces. Initially, the exchanges were supposed to allow employers to choose different plans for different workers; now, for the first year, they must select only one plan from a single carrier for their entire business. More recently, the Government Accountability Office announced that federal and state officials have fallen well behind schedule setting up the marketplaces, which are scheduled to open for enrollment in October. “This is simply the latest evidence that implementation of this terrible law is going to be difficult if not impossible, and the burden is going to fall on the people who create American jobs,” Amanda Austin, director of federal public policy at the National Federation of Independent Business, said in a statement. The NFIB, a small business lobbying group, has pushed back against the health care law since it was making its way through Congress, later spearheading an effort to repeal the legislation that ended at the hands of the Supreme Court. The group has since focused on repealing some of the provisions it considers most detrimental to businesses on Main Street, including the employer mandate and a new tax on insurers. Instead of delayed, Austin argued the mandate should be eliminated altogether. “Temporary relief is small consolation,” she said. “We need a permanent fix to this provision to provide long term relief for small employers.” – See more at: http://congress.org/2013/07/04/delayed-employer-mandate-the-latest-change-for-increasingly-unsteady-health-care-law/#sthash.JwCb3wWY.dpuf

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