Obamacare: Are All Bets Off For 2018 Open Enrollment?

By D. Kenton Henry, Editor, Broker, Agent

Last evening I began to receive texts and messages inquiring how President Trump’s executive order (EO) on Thursday, October 12th, would impact both the near and long-term future of Obamacare. Before retiring for the evening, I responded – “In the long run, dramatically. But in the short run, not so much because it will take quite awhile for the insurance industry to respond appropriately.” At that time, all I had learned was, the President ordered regulators to allow consumers to shop across state lines for health insurance along with the ability individuals of like professions, careers, and risk profiles, to band together in associations for the purpose of acquiring individual and family health insurance. Theoretically, the first would allow the consumer to shop for their best value among a far greater number of companies and plans, thus restoring competition to the market. The second would allow pooling a large number of people, and the resulting volume would lower risk to the insurance companies, thus allowing them to charge lower premiums to the members. The same principle and effect currently available to employer groups. And that was all I was aware of regarding the EO. Additionally, the EO loosens the restrictions on “Short-Term” health insurance, allowing it to serve as a viable alternative to long-term coverage for the young and/or healthy.

Today, I awakened to learn the Department of Health and Human Services announced late last night that the EO includes the cessation of federal payments for Cost-Sharing Reductions (CSRs) to insurance companies. “Immediately.” This, according to Secretary Eric Hargan and Medicare administrator, Seema Verma. And―with that―all bets are off! The Administration claims this can be done because Congress never appropriated funds for the CSRs. These funds were used to reimburse insurers for the CSRs which result in reductions in deductibles, copays, and out-of-pocket maximums for eligible individuals. However, while the insurers will lose these subsidies (amounting to $7 billion this year), they remain obligated to continue offering them to eligible customers! Eligible customers mostly include those qualifying for subsidies and electing “Silver” plans through the Marketplace, Healthcare.gov. At the very least, halting the payments could trigger a spike in premiums, at some point, for the coming year, unless Congress authorizes the money. The next payments are due around October 20th. The Congressional Budget Office estimates, without the subsidies, premiums could go up by as much as 20%. That is on top of the 15-20% average increase anticipated with the subsidies in place! Nearly 3 in 5 Healthcare.gov customers qualify for help. If you qualify for a premium subsidy, the increase will simply be paid for by your fellow taxpayers as it has the last four years. The person or family who does not qualify will have to pay for it entirely out of their own pocket. As always, it is the hard working middle class who could be hurt the most. Those who make just enough to get by, but a little too much to qualify for government assistance.

Will this break Obamacare altogether and, if so, when? What impact will it have on 2018 individual and family health insurance premiums? Rates had to be (and were) submitted to state health insurance commissioners, as required, on September 30th. Can insurance companies pull out of the market at this point? Will they? Apparently, Premium Subsidies (separate from CSRs), designed to lower premiums, per se, for qualified individuals – as well as though qualifying for tax credits upon filing – will not be affected. However, here is what the Washington Post (article below) had to say about the cessation of CSR subsidies, alone: “Ending the payments is grounds for any insurer to back out of its federal contract to sell health plans for 2018. Some state’ regulators directed ACA insurers to add a surcharge in case the payments were not made, but insurers elsewhere could be left in a position in which they still must give consumers the discounts but will not be reimbursed.” In my opinion, it is too late to submit new rates for approval in time for Open Enrollment, just around the corner. But it is not too late for an insurance company to pull out of the market altogether. What options will that leave the consumer, including my clients, for coverage in 2018 and beyond?

I agree with the administration; this is their move to force the hand of Congress to reverse the policies of Obamacare, restore competition and consumer choice, to the market. It will allow elements of a free market to regulate the variables, most important of which are, benefits, choice of provider, and premium. How long it will take for this action on the part of the Trump to accomplish this, I can’t say. The Executive Order is almost certain to be challenged by state Attorney Generals and litigated in federal courts. This could take months, or more, to play out, and probably will.

I apologize that, at this point, I have more questions than answers. In the meantime, I, and, my clients have yet to learn what our 2018 health options and premiums would be (or would have been) without the ramifications of the Executive Order. Rest assured, I will be watching in earnest for the details as this situation evolves.

As always, please feel free to phone me at 281.367.6565; text me at 713.907.7984 or email me at allplanhealthinsurance.com@gmail.com. The closer we get to November 1, the more I will know. And whatever is available to you, I will have. Along with your best option. Bear in mind, “best” is a relative term.

http://TheWoodlandsTXHealthInsurance.com https://HealthandMedicareInsurance.com

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Featured article:

WASHINGTON POST
By Amy Goldstein and Juliet Eilperin By Amy Goldstein and Juliet Eilperin
Health & Science
October 13 at 9:42 AM

President Trump is throwing a bomb into the insurance marketplaces created under the Affordable Care Act, choosing to end critical payments to health insurers that help millions of lower-income Americans afford coverage. The decision coincides with an executive order on Thursday to allow alternative health plans that skirt the law’s requirements.
The White House confirmed late Thursday that it would halt federal payments for cost-sharing reductions, although a statement did not specify when. Another statement a short time later by top officials at the Health and Human Services Department said the cutoff would be immediate. The subsidies total about $7 billion this year.
Trump has threatened for months to stop the payments, which go to insurers that are required by the law to help eligible consumers afford their deductibles and other out-of-pocket expenses. But he held off while other administration officials warned him such a move would cause an implosion of the ACA marketplaces that could be blamed on Republicans, according to two individuals briefed on the decision.
Health insurers and state regulators have been in a state of high anxiety over the prospect of the marketplaces cratering because of such White House action. The fifth year’s open-enrollment season for consumers to buy coverage through ACA exchanges will start in less than three weeks, and insurers have said that stopping the cost-sharing payments would be the single greatest step the Trump administration could take to damage the marketplaces — and the law.
Ending the payments is grounds for any insurer to back out of its federal contract to sell health plans for 2018. Some states’ regulators directed ACA insurers to add a surcharge in case the payments were not made, but insurers elsewhere could be left in a position in which they still must give consumers the discounts but will not be reimbursed.
A spokeswoman for America’s Health Insurance Plans, an industry trade group that has been warning for months of adverse effects if the payments ended, immediately denounced the president’s decision. “Millions of Americans rely on these benefits to afford their coverage and care,” Kristine Grow said.
And California Attorney General Xavier Becerra (D), who has been trying to preserve the payments through litigation, said the president’s action “would be sabotage.” Becerra said late Thursday that he was prepared to fight the White House. “We’ve taken the Trump Administration to court before and won, and we’re ready to do it again if necessary,” he said in a statement.
Trump’s move comes even as bipartisan negotiations continue on one Senate committee over ways to prop up the ACA marketplaces. Both Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) have publicly said the payments should not end immediately, though they differ over how long these subsidies should be guaranteed.
The cost-sharing reductions — or CSRs, as they are known — have long been the subject of a political and legal seesaw. Congressional Republicans argued that the sprawling 2010 health-care law that established them does not include specific language providing appropriations to cover the government’s cost. House Republicans sued HHS over the payments during President Barack Obama’s second term. A federal court agreed that they were illegal, and the case has been pending before the U.S. Court of Appeals for the D.C. Circuit.
President Trump signed an executive order on the Affordable Care Act on Oct. 12. With the order, he directed federal agencies to rewrite regulations on selling a certain type of health insurance across state lines. President Trump signed an executive order on the Affordable Care Act on Oct. 12. (Photo: Jabin Botsford/The Washington Post)
President Trump signed an executive order on the Affordable Care Act on Oct. 12. With the order, he directed federal agencies to rewrite regulations on selling a certain type of health insurance across state lines. (The Washington Post)
“The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system,” a statement from the White House said. “Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people.”
In a filing Friday morning, the administration informed the court that HHS had “directed that cost-sharing reduction payments be stopped because it has determined that those payments are not funded by the permanent appropriation.”
House Speaker Paul D. Ryan (R-Wis.) said in a statement that the administration was dropping its appeal of the lawsuit — something the White House did not mention in its announcement. Ryan called the move to end to the court case “a monumental affirmation of Congress’s authority and the separation of powers.”
Meanwhile, the top two congressional Democrats, House Minority Leader Nancy Pelosi (Calif.) and Senate Minority Leader Charles E. Schumer (N.Y.), excoriated the president’s decision. “It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America,” they said in a joint statement. “Make no mistake about it, Trump will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it.”
For months, administration officials have debated privately about what to do. The president has consistently pushed to stop the payments, according to officials and advisers who spoke on the condition of anonymity to discuss private conversations. Some top health officials within the administration, including former HHS secretary Tom Price, cautioned that this could exacerbate already escalating ACA plan premiums, these Republicans said. But some government lawyers argued that the payments were not authorized under the existing law, according to one administration official, and would be difficult to keep defending in court.
Acting HHS secretary Eric Hargan and Seema Verma, administrator of the department’s Centers for Medicare and Medicaid Services, said they were stopping the payments based on a legal opinion by Attorney General Jeff Sessions. “It has been clear for many years that Obamacare is bad policy. It is also bad law,” their statement says. “The Obama Administration unfortunately went ahead and made CSR payments to insurance companies after requesting — but never ultimately receiving — an appropriation from Congress as required by law.”
While the administration will now argue that Congress should appropriate the funds if it wants them to continue, such a proposal will face a serious hurdle on Capitol Hill. In a recent interview, Rep. Tom Cole (R-Okla.), who chairs the House Appropriations Subcommittee overseeing HHS, said it would be difficult to muster support for such a move among House conservatives.
One person familiar with the president’s decision said HHS officials and Trump’s domestic policy advisers had urged him to continue the payments at least through the end of the year.
The cost-sharing payments are separate from a different subsidy that provides federal assistance with premiums to more than four-fifths of the 10 million Americans with ACA coverage.
Word of the president’s decision came just hours after he signed the executive order intended to circumvent the ACA by making it easier for individuals and small businesses to buy alternative types of health insurance with lower prices, fewer benefits and weaker government protections.
The White House and allies portrayed the president’s move as wielding administrative powers to accomplish what congressional Republicans have failed to achieve: fostering more coverage choices while tearing down the law’s insurance marketplaces. Until the White House’s announcement late Thursday, the executive order represented Trump’s biggest step to date to reverse the health-care policies of the Obama administration, a central promise since last year’s presidential campaign.
Critics, who include state insurance commissioners, most of the health-insurance industry and mainstream policy specialists, predict that a proliferation of these other kinds of coverage will have damaging ripple effects, driving up costs for consumers with serious medical conditions and prompting more insurers to flee the law’s marketplaces. Part of Trump’s action, they say, will spark court challenges over its legality.
The most far-reaching element of the order instructs a trio of Cabinet departments to rewrite federal rules for “association health plans” — a form of insurance in which small businesses of a similar type band together through an association to negotiate health benefits. These plans have had to meet coverage requirements and consumer protections under the 2010 health-care law, but the administration is likely to exempt them from those rules and let such plans be sold from state to state without insurance licenses in each one.
In addition, the order is designed to expand the availability of short-term insurance policies, which offer limited benefits as a bridge for people between jobs or young adults no longer eligible for their parents’ health plans. The Obama administration ruled that short-term insurance may not last for more than three months; Trump wants to extend that to nearly a year.
Trump’s action also is intended to widen employers’ ability to use pretax dollars in “health re-imbursement arrangements” to help workers pay for any medical expenses, not just for health policies that meet ACA rules — another reversal of Obama policy.
In a late-morning signing ceremony in the White House’s Roosevelt Room, surrounded by supportive small-business owners, Cabinet members and a few Republicans from Capitol Hill, the president spoke in his characteristic superlatives about the effects of his action and what he called “the Obamacare nightmare.”
Trump said that Thursday’s move, which will trigger months of regulatory work by federal agencies, “is only the beginning.” He promised “even more relief and more freedom” from ACA rules. And although leading GOP lawmakers are eager to move on from their unsuccessful attempts this year to abolish central facets of the 2010 law, Trump said that “we are going to pressure Congress very strongly to finish the repeal and replace of Obamacare.”
But in an early morning tweet Friday, Trump reached out to Democrats with an appeal to somehow work together on a health-care “fix.”
“The Democrats ObamaCare is imploding,” Trump wrote. “Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!”
The executive order will fulfill a quest by conservative Republican lawmakers, especially in the House, who have tried for more than two decades to expand the availability of association health plans by allowing them to be sold, unregulated, across state lines. On the other hand, Trump’s approach conflicts with what he and GOP leaders in Congress have held out as a main health-policy goal — giving each state more discretion over matters of insurance.
Health policy experts in think tanks, academia and the health-care industry pointed out that the order’s language is fairly broad, so the ensuing fine print in agencies’ rules will determine whether the impact will be as sweeping or quick as Trump boasted — his directive will provide “millions of people with Obamacare relief,” he said.
Significant questions that remain include whether individuals will be able to join associations, a point that could raise legal issues; whether the administration will start to let association health plans count toward the ACA’s requirement that most Americans carry insurance; and whether such plans can charge higher prices to small businesses with sicker workers — or refuse to insure them.
A senior administration official, speaking to reporters on the condition of anonymity shortly before Trump signed the order, said that the policy changes it sets in motion will require agencies to follow customary procedures to write new rules and solicit public comment. That means new insurance options will not be available in time for coverage beginning in January, he said.
Among policy experts, critics warned that young and healthy people who use relatively little insurance will gravitate to association health plans because of their lower price tags. That would concentrate older and sicker customers in ACA marketplaces with spiking rates.

Selling health plans from state to state without separate licenses — the idea underlying much of the president’s order — has long been a Republican mantra. It has gained little traction in practice, however.
Half a dozen states — before the ACA was passed in 2010 as well as since then — have passed laws permitting insurers to sell health policies approved by other states. And since last year, the ACA has allowed “compacts” in which groups of states can agree that health plans licensed in any of them could be sold in the others. Under such compacts, federal health officials must make sure the plans offer at least the same benefits and are as affordable as those sold in the ACA marketplaces.
As of this summer, “no state was known to actually offer or sell such policies,” according to a report by the National Conference of State Legislatures. A main reason, experts say, is insurers’ difficulty in arranging networks of doctors and other providers of care far from their home states.

THE FUTURE OF HEALTH INSURANCE IN 2018

Shortly after 1:30 a.m. Friday, July 28th, the U.S. Senate voted 49-51 to reject the Health Care Freedom Act (HCFA), a “skinny repeal” of the ACA. The pared-down version was attempted after previous efforts to pass a more sweeping repeal of the law have failed. Senate Majority Leader Mitch McConnell (R-KY) began floating the idea early in the week before ultimately releasing the text of the bill at 10 p.m. Thursday, just two hours before the vote. Republican Senators Susan Collins (ME), Lisa Murkowski (AK), and John McCain (AZ) joined all Democrats in voting no, while all other Republicans voted in favor. With the failure of this vote, congressional Republicans will no longer be able to use the budget reconciliation process to repeal provisions of the ACA until the next fiscal year and will instead have to move legislation under regular order that would require 60 votes for passage in the Senate. ― NAHU 7/28 (washingtonupdate@nahu.org)

Anyone who tells you they know what the next few months before health insurance OPEN ENROLLMENT  (OE)―the period during which individuals and families may apply for and obtain coverage for the coming calendar year―will produce definitively, is deluding themselves. OE is scheduled to begin November 1 and run through December 7th. At this point, the only safe prediction is the preservation of the status quo. In other words, premiums will increase another 15 to 25% minimum; there will be fewer options regarding carriers and plans and fewer in-network medical providers from which to choose. In some parts of the country, it will be even worse, with only one carrier to choose from and―in some cases ― none. Whether that will be the case in Texas remains to be seen.

Here is what we do know:

1) Premiums will increase significantly in most areas

2) In the area of Houston, one more carrier―Memorial Hermann Health Plan―has announced they are withdrawing from the market. All of their current policyholders must find replacement coverage for 2018.

3) Humana has canceled all their current individual and family plans effective July 1 and will not participate in the market in 2018. This is in addition to Aetna, Cigna’s and Unitedhealthcare’s withdrawal from the market in 2017.

4) Residents of Harris, Fort Bend, and Montgomery Counties will (hopefully) have only plans from BlueCross BlueShield of Texas, Community Health Choice, and Molina Healthcare from which to choose.

5) The only remaining network option available from the above-referenced carriers will be Health Maintenance Organization (HMO) plans where the insured individual must seek treatment within the network or have no coverage whatsoever.

Here is an important change this editor (who is also a health insurance broker) recently learned. Married couples who are small business owners seeking Preferred Provider Organization (PPO) coverage as a way of having access to providers and treatment―will no longer be eligible for coverage with most (if not all) small group carriers unless they had a minimum average of one W-2 employee in the previous calendar year. This new stipulation would have prevented many of my business owner clients from obtaining the group PPO health insurance they now have, had it been in effect before January 1 of 2017. A prospective client of mine whose family coverage was canceled by Humana, July 1―in the midst of cancer treatment―now finds himself denied covered access to his oncologist and hospital. It appears all ongoing medical treatment from those providers, at least through the remainder of the year, will be self-funded. If you are a small business owner considering moving to group insurance in 2108, bear this in mind and begin paying at least one employee W-2, full time, through the remainder of 2017.

Small business owners considering a move to small group coverage who can meet this eligibility requirement, please contact me for assistance in making the transition.

For individuals and families who do not have a business, or employer sponsored health insurance, I will have whatever health insurance options are available to residents of your county and will soon begin testing and certifying (as I must each fall) to market these plans for the coming calendar year. I will be able to assist you whether you qualify for a subsidy of your health insurance premium or do not. If you do, I believe it will be much easier to obtain your subsidy and health insurance through me than by dealing with the marketplace, Healthcare.gov. If you do not qualify for a one, I have a strategy for minimizing your premium while giving you access to the provider of your choice. It is not appropriate for everyone, but it has worked for many of my clients.

Please contact me at 281-367-6565; text me at 713-907-7984, or email me at allplanhealthinsurance.com@gmail.com

Though I see little reason to be optimistic for a solution to the aforementioned problems until the Patient Protection and Affordable Care Act (Obamacare) implodes entirely, and Congress is forced to unite to provide a workable solution, let’s hope enough reasonable minds prevail before it comes to that. In the meantime, I am here to assist in acquiring the best available option, as I have for the past 26 years.

―D. Kenton Henry, editor, agent, broker

http://TheWoodlandsTXHealthInsurance.com

https://healthandmedicareinsurance.com

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FEATURED ARTICLE

GOP leaders say it’s time for Senate to move on from health care

(Jenny Starrs/The Washington Post)

By Sean Sullivan By Sean Sullivan July 31 at 9:24 PM

Senate Republican leaders signaled Monday that they intend to move on from health care to other legislative priorities, even as President Trump continued to pressure lawmakers to repeal and replace the Affordable Care Act.

The discord comes amid uncertainty in the insurance industry and on Capitol Hill about what will come next after last week’s dramatic collapse of the GOP’s effort to scrap the seven-year-old landmark law. Trump on Monday threatened to end subsidies to insurers and also took aim at coverage for members of ­Congress.

But the White House insistence appears to have done little to convince congressional GOP leaders to keep trying. One after another on Monday, top GOP senators said that with no evidence of a plan that could get 50 votes, they were looking for other victories.

“We’ve had our vote, and we’re moving on to tax reform,” said Sen. John Thune (S.D.), one of Senate Majority Leader Mitch McConnell’s top lieutenants, speaking of the next big GOP legislative priority.

Sen. Roy Blunt (Mo.), another member of the Republican Senate leadership, put it this way: “I think it’s time to move on to something else. Come back to health care when we’ve had more time to get beyond the moment we’re in — see if we can’t put some wins on the board.”

McConnell did not address health care in his remarks opening Senate business on Monday afternoon. His top deputy, Sen. John Cornyn (Tex.), brushed back comments White House budget director Mick Mulvaney made on CNN on Sunday urging Republicans not to vote on anything else until voting on health care again.

“I don’t think [Mulvaney’s] got much experience in the Senate, as I recall,” said Cornyn as he made his way into the Senate chamber. “And he’s got a big job. He ought to do that job and let us do our job.”

Mulvaney was echoing what Trump tweeted Saturday: “Unless the Republican Senators are total quitters, Repeal & Replace is not dead! Demand another vote before voting on any other bill!”

On Monday, Trump tweeted: “If Obamacare is hurting people, & it is, why shouldn’t it hurt the insurance companies & why should Congress not be paying what public pays?” He was referencing subsidies that members of Congress receive to help offset their coverage costs purchased through the District’s exchanges, as required under the Affordable Care Act.

Sen. Rand Paul (R-Ky.) said Monday that based on a conversation he had with Trump, the president is considering taking executive action on health care, Reuters reported. A Paul spokesman did not immediately respond to a request for comment, and it was not clear what such an action could be. Health and Human Services Secretary Tom Price indicated over the weekend that he was considering using his regulatory authority to waive the Affordable Care Act’s mandate that all Americans buy coverage or pay a tax.

Some rank-and-file Republican lawmakers have used the collapse of repeal-and-replace to offer new fixes and improvements to health care, but there was no sign their leaders were engaged. On Monday, Price met with fellow physician Sen. Bill Cassidy (R-La.), who has proposed restructuring how federal money is distributed under the Affordable Care Act. Separately, a bipartisan group of 43 House members released details of their own plan.

“We had a productive meeting. All involved want a path forward,” said Cassidy in a statement after his White House meeting, also attended by several governors. In addition to turning over federal funds to the states, Cassidy and Sens. Lindsey O. Graham (R-S.C.) and Dean Heller (R-Nev.) have proposed repealing key mandates and a tax under the law.

But there are no signs that plan will be put to a vote any time soon. It has not been scored by the nonpartisan Congressional Budget Office. It’s unclear how many Republicans would vote for it. And McConnell is working on confirming Trump’s nominees this week.

A growing number of Republican lawmakers have raised the prospect of working with Democrats on health care. The collection of centrist House Republicans and Democrats unveiled a proposal Monday calling for revisions they said would help stabilize the individual insurance ­market.

Rep. Tom Reed (R-N.Y.), a co-chair of the centrist Republican and Democratic “Problem Solvers Caucus,” which released the plan, said he and his colleagues have been working on a draft for about three weeks, as they saw “the writing on the wall” that the Senate bill was likely to fail.

House Speaker Paul D. Ryan (R-Wis.) did not champion the plan. AshLee Strong, his press secretary, said in an email: “While the speaker appreciates members coming together to promote ideas, he remains focused on repealing and replacing Obamacare.”

Strong did not respond to a follow-up question about how that ought to happen. The House passed a sweeping rewrite of the Affordable Care Act this year, with only Republicans voting for it.

The Senate tried to pass its own version but was unable to reach an accord, even on a more modest bill that was meant to keep the talks alive in both chambers. That bill was rejected Friday when Sen. John McCain (R-Ariz.) joined two other Republicans to sink the legislation in a tension-filled vote that happened while most of the country was asleep.

In their outline, Reed and his colleagues said federal cost-sharing subsidies should be placed under congressional oversight and that mandatory funding should be assured. Now such disbursements are up to the Trump administration, which has been paying them monthly but has threatened to withhold them.

Top Democrats and Republicans warned against that.

“Right now, as insurers prepare to lock in their rates and plans for 2018, the Trump administration is dangling a massive sword of Damocles over the heads of millions of Americans — threatening to end payments the administration is supposed to make that would lower deductibles and out-of-pocket costs for so many Americans,” said Senate Minority Leader Charles E. Schumer (D-N.Y.) on the Senate floor.

Thune said he was “hopeful” the administration would keep making the payments.

After Friday’s vote, some Democrats have felt more empowered to talk about changes to the Affordable Care Act. The centrist House lawmakers want to repeal the 2.3 percent tax on medical device manufacturers and loosen the employer mandate under the Affordable Care Act. The law says companies with 50 or more full-time employees must offer coverage. They want to raise the threshold to 500.

They also said they want to create a state stability fund to reduce premiums and spur more innovation at the state level.

Getting health-care legislation backed only by Republicans to Trump’s desk by the end of August is all but impossible, even if they suddenly put aside their disagreements. The House is in recess until September. The Senate is scheduled to be in session the first two weeks of August.

The prospects of a bipartisan deal were just as doubtful, amid fierce partisanship that has gripped the Capitol in the Trump era, which has shown no signs of abating. Even those pushing for one were tempering expectations.

“We’re not stupid,” Reed said. “Those partisan swords — they’re going to be out there.”

Paige Winfield Cunningham contributed to this report

BULLETIN: Second Round of Obamacare Breaks From The Gate Starting Now!

HEALTH INSURANCE PREMIUMS 2015

(Announcement by D. Kenton Henry and HealthandMedicareInsurance.com)

Who will end up the winner ― you ― the insured, the insurance companies or Uncle Sam?

As a health insurance broker of 27 years, I and my peers have waiting with baited breath all year to see two things:

First ― will enrollments in 2015 health insurance plans, which begin at midnight tonight, the 15th of November, go more smoothly than last year’s embarrassing debacle that was the glitch plagued Healthcare.gov website which floundered in the death throes of end-stage technology through the entire first year “open-enrollment” period?

Secondly ― what are 2015 premiums and benefits going to look like? By the time you read this, you are about to know. I hope you will be happy with the options available to you, however, I hate to say, I cannot guarantee that. Rumor has it that premiums will be going up at varying rates relative to each of the fifty states. In Texas they are projected to rise an average of 14%  above 2014 rates depending on your age. If this is the case and you have coverage you feel is adequate―along with the option of keeping it―that is exactly what you should do. But if you are like a great number of my clients, who have been told your current plan will terminate 12.31.2014,  your only options are to forego coverage and pay the penalty (excuse me “shared responsibility tax”) when you file your 2015 tax return. Or purchase one of the new compliant plans.

I cannot control the options you will have but I can present, simplify and guide you to your best value in 2015 health insurance coverage. My quoting link will not only determine if you qualify for and calculate the amount of your subsidy (utilizing the same algorithm employed by Healthcare.gov) but, in the event you do qualify, will allow you to seamlessly take advantage of the subsidy and apply for your health plan selection for the reduced (net) premium. It will illustrate all your options from every carrier both on and off the federal exchange.

I am certain that after reviewing your options you will have numerous questions. I encourage you to email or call me with them. I will answer them and once you have decided upon your best value, I can make the enrollment process go as smoothly and comfortably as possible. I intend to work all through the weekend and make myself available to be best of my ability.

It is currently 10 p.m. CST on the 14th. After midnight click on this link to begin exploring your options and know I greatly anticipate working with you and making this transition period in the health insurance consumer market go as smoothly as possible for you.

Sincerely,

Kenton Henry

Broker, Agent, Editor

Email: Quote@allplaninsurance.com

Phone: 281.367.6565

Toll Free: 800.856.6556

CLICK HERE FOR 2015 HEALTH INSURANCE OPTIONS: https://allplanhealthinsurance.insxcloud.com/my-quote/individual-info

*Please return to this page and give us your opinion of your options.

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FEATURE ARTICLES:

NEW YORK TIMES

14 November 2014

Cost of Coverage Under Affordable Care Act to Increase in 2015

By ROBERT PEAR, REED ABELSON and AGUSTIN ARMENDARIZNOV. 14, 2014

“Consumers should shop around,” said Marilyn B. Tavenner, administrator of the Centers for Medicare and Medicaid Services, which runs the federal insurance exchange serving three dozen states. “With new options available this year, they’re likely to find a better deal.” She asserted that the data showed that “the Affordable Care Act is working.”

But Republicans quickly pounced on the data as evidence of the opposite.

“Last year, many who liked their plan were surprised to learn they couldn’t keep it,” said Senator Orrin G. Hatch of Utah, who is in line to become chairman of the Senate Finance Committee. “This year, many who like their plan will likely have to pay more to keep it.”

The new data means that many of the seven million people who have bought insurance through federal and state exchanges will have to change to different health plans if they want to avoid paying more — an inconvenience for consumers just becoming accustomed to their coverage.

A new Gallup Poll suggests that seven in 10 Americans with insurance bought through the exchanges rate the coverage and the care as excellent or good, and most were planning to keep it.

In employer-sponsored health plans, employees tend to stay with the same insurer from year to year. But for consumers in the public insurance exchanges, that will often be a mistake, experts said.

Nashville illustrates the need for people with marketplace coverage to look closely at the alternatives available in 2015.

Marilyn B. Tavenner, administrator of the Centers for Medicare and Medicaid Services, which runs the federal health exchange. Credit Doug Mills/The New York Times

A 40-year-old in Nashville, with the cheapest midlevel, or silver plan, will pay $220 a month next year, compared to $181 a month this year, for the same plan.

The least expensive plan is offered by another insurer, Community Health Alliance, one of the so-called co-op plans created under the federal law. It offers coverage for a monthly premium of $194.

But the lower premium means that consumers will have to pay a much larger annual deductible, $4,000, rather than $2,000. A policyholder who becomes seriously ill or has a costly chronic condition could pay hundreds of dollars in out-of-pocket expenses.

In addition, different health plans often have different networks of doctors and hospitals and cover different drugs, meaning that consumers who change plans may have to pay more for the same medicines.

Another problem for consumers is that if the price for a low-cost benchmark plan in the area has dropped, the amount of federal subsidies provided by the law could be less, meaning that consumers may have to pay more unless they switch.

The data, released by the Centers for Medicare and Medicaid Services, indicates that price increases will be modest for many people willing to change plans. In a typical county, the price will rise 5 percent for the cheapest silver plan and 4 percent for the second cheapest.

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NEW YORK TIMES

Estimate of Healthcare Enrollment Leaves Room to Grow

10 November 2014

WASHINGTON — The Obama administration on Monday offered a surprisingly modest estimate of the number of people who would sign up for health insurance in the second round of open enrollment, which begins on Saturday.

Sylvia Mathews Burwell, the secretary of health and human services, said she was working on the assumption that a total of 9.1 million people would have such coverage at the end of next year.

By contrast, the Congressional Budget Office had estimated that 13 million people would be enrolled next year, with the total rising to 24 million in 2016. In the past, the White House has used the budget office numbers as a benchmark for success under the Affordable Care Act.

This estimate appeared to be part of an effort by federal officials to lower public expectations, so the goal would be easier to meet and to surpass. In addition, the new number could indicate that administration officials believe it will be difficult to find and enroll many of the uninsured while retaining those who signed up in the last year.

“The number we are going to aim for this year is 9.1 million,” Ms. Burwell said on Monday during remarks at the Center for American Progress, a liberal research and advocacy group.

Ms. Burwell’s estimate was at the lower end of the range suggested by health policy experts in her department. In a report issued earlier Monday, the experts estimated that, at the end of next year, 9 million to 9.9 million people would have coverage purchased through insurance exchanges, or marketplaces.

Representative Marsha Blackburn, Republican of Tennessee, said the administration was “trying to manage expectations and rewrite its definition of success ahead of the second open-enrollment period.” Administration officials said they were just being realistic, in the light of experience with other health programs.

President Obama announced in April that eight million people had signed up for health insurance under the Affordable Care Act. Officials said Monday that enrollment had declined to 7.1 million after some people failed to pay their share of premiums and others were found to be ineligible because of unresolved questions about their citizenship or immigration status.

The Department of Health and Human Services estimated that enrollment, including renewals and new customers, would reach 10 million to 11 million by the end of the three-month sign-up period, which closes on Feb. 15.

However, if Ms. Burwell is right, the number would shrink to 9.1 million people at the end of next year. That would still be a 28 percent increase over the number believed to have marketplace coverage today.

Ms. Burwell’s estimate came as a surprise to insurance counselors, agents and brokers working with the Obama administration.

Anne Filipic, the president of Enroll America, a nonprofit group trying to expand coverage, said the goal of 9.1 million “seems reasonable.” She praised the administration for taking what she described as “a pragmatic, analytic approach” to setting a numeric goal.

Federal health officials said they had ended coverage for 112,000 people who could not demonstrate that they were United States citizens or legal immigrants entitled to insurance under the health care law.

In addition, they said, 120,000 households will lose some or all of the insurance subsidies they have been receiving because they could not adequately document their income. These households will face higher premiums.

In making their estimates, federal health officials said, they assumed that 83 percent of the people with marketplace coverage — 5.9 million of the 7.1 million people in “qualified health plans” — would renew their coverage.

The intense political debate swirling around the Affordable Care Act does not make the job of enrolling people any easier, officials said.

Republicans like Tom Cotton in Arkansas and Joni Ernst in Iowa won Senate races in which they emphasized opposition to the health care law, as did successful Republican House candidates like Mia Love in Utah and Ryan Zinke in Montana.

Senator John Barrasso of Wyoming, the chairman of the Senate Republican Policy Committee, said that people were skeptical of the law and “aren’t signing up because they realize it’s not a good deal for them.”

The Supreme Court said on Friday that it would consider a case challenging subsidies paid to more than four million people who obtained insurance through the federal marketplace.

Ms. Burwell said Monday that she did not see the legal challenge as a serious threat to the Affordable Care Act. “As we go into open enrollment,” she said, “nothing has changed.”

Federal health officials said they believed that marketplace enrollment would grow more slowly than projected by the Congressional Budget Office, which sees the total holding steady at 25 million from 2017 to 2024.

Administration officials noted that uninsured people could also get coverage by enrolling in Medicaid or by finding jobs with health benefits.

In a brief analysis of coverage trends, the Department of Health and Human Services said Monday that “most of the new marketplace enrollment for 2015 is likely to come from the ranks of the uninsured,” rather than from people who previously bought insurance on their own outside the exchanges.

“Happy Anniversary Healthcare.Gov!” (Do We Want A Divorce?)

Op-ed by D. Kenton Henry

BIRTHDAY CAKE

 

Happy anniversary, Healthcare.gov! Today, October 1st, marks the first anniversary of the premier of the originally beleaguered Federally Facilitated “Marketplace” (FFM), the federal government website for the purchase of Affordable Care Act (ACA) compliant health insurance plans in states which did not implement their own. And what of it now?

After a rollout, which was anything but smooth, and a current expenditure of approximately $2.1 billion dollars (after a winning bid of $90 million) the site seems to have solved the majority of its “front- end” issues. These involve opening an account; verifying identity and plan selection. But in light of notice that the time has run out for those who did not succeed in providing adequate proof of income for subsidy (“Premium Tax Credit”) purposes thereby resulting in their loss of coverage or―at least the subsidy―one is left wondering what if anything will change relative to this “back-end” issue for 2015. According to a September 15th article in the New York Times, approximately half a million insured face a forced plan change. “363,000 could lose their premium subsidies due to an inability to verify income, while 115,000 more could have their policies canceled because they have not proven their immigration status. Federal authorities have been working for months to resolve both backlogs.”

My BlueCross BlueShield of Texas clients who have “grand-mothered” plans just received notice dated today that “The health plan you now have will no longer be available and cannot be renewed”. Grand-mothered plans are those which have been modified in anyway, such as a change in deductible, but purchased prior to January 1 of this year when all new policies were required to be ACA compliant. Termination will be effective the end of 12.31.2014 and the client, insured will have until that date to enroll in a new plan for seamless coverage beginning January 1. These policyholders are instructed to log in starting November 15th to review their options and elect new coverage through BlueCross BlueShield. What will the benefits look like and what will be the cost? Well, we won’t know until November 15th. The consensus seems to be that premiums in all but a few locations will be increasing somewhat across the market compared to this year’s ACA compliant plans but at less than the average rate of medical inflation in recent years. (Call me skeptical.) But what about compared to their grand-mothered plan? No way. By the time you add in the additional cost of mandated coverage for benefits such as pediatric dental and vision, maternity and the rest of the “minimum essential health benefits” along with guarantee issue for pre-existing conditions, there is no way these policyholders are going to be pleased with the premiums their new options will cost. If they had thought the marketplace offered better options, they would have elected them for 2014. I am certain the words, “If you like your plan, you can keep your plan. Period.” will be ringing in their ears as they peruse their new options.

On the upside, an estimated 25% additional insurance companies will be providing coverage for 2015 both in and out of the marketplace and state exchanges. This increased competition will give consumerd more options and will hopefully help offset some of the inflationary aspects of mandated coverage in future years.

On the downside, what of the “It’s a penalty … not a tax!” ― now known as the “Shared Responsibility Payment” ― for not having coverage in 2015? That increases to $325 per adult and $162.50 per child or 2% of household income ― whichever is higher. (Family maximum is $975.) It will increase every year hereafter, tied to the rate of inflation beyond 2016.

Additional variables remain to be seen such as “provider selection”. While pressure is being put on insurance companies to increase the number of in-network providers available to the insured, surveys seem to indicate more providers are electing not to join. They feel payments have dropped to low to make it worth their while to participate. Insurance companies are going have to find alternative ways to control costs and since they cannot control the risk they are forced to assume (elative to pre-existing conditions and the mandated “loss ratio”) they are going to ration our providers and our treatment.

On a final note, the enrollment period for 2015 plans will be half as long as for 2014 and will end February 15th. So get ready to be like the sheep, in the Wild Kingdom segment, passing through the anaconda. It’s going to be a tight squeeze! And once again . . . “Happy Anniversary to Healthcare.gov!”

By all means, please contact me if you feel I can make the celebration cake a little more palatable!

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FEATURED ARTICLE:

The New York Times

U.S. to End Coverage Under Health Care Law for Tens of Thousands

By ROBERT PEAR SEPT. 15, 2014

WASHINGTON — The Obama administration said on Monday that it planned to terminate health insurance for 115,000 people on Oct. 1 because they had failed to prove that they were United States citizens or legal immigrants eligible for coverage under the Affordable Care Act. It also told 363,000 people that they could lose financial aid because their incomes could not be verified.

The 115,000 people “will lose their coverage as of Sept. 30,” said Andrew M. Slavitt, the No. 2 official at the Centers for Medicare and Medicaid Services, which runs the federal insurance marketplace.

Some of them may be able to have their coverage reinstated retroactively if they produce the documents that they were repeatedly asked to provide in recent months, Mr. Slavitt said.

At the end of May, the administration said, 966,000 people were found to have discrepancies in their immigration and citizenship records. Most sent in documents as requested. In mid-August, the administration sent letters to about 310,000 people who had failed to respond. They were supposed to submit documents by Sept. 5, but the 115,000 consumers failed to do so, Mr. Slavitt said.

Many consumers and lawyers who work with them said that they had tried to submit immigration and citizenship papers, but that they experienced problems transmitting documents through HealthCare.gov. Other people said they sent the documents by mail to a federal contractor in Kentucky but never heard back from the contractor or the government.

“We heard from lots of consumers who told us they sent in their documents multiple times or tried to upload them through HealthCare.gov,” said Mara Youdelman, a lawyer at the National Health Law Program, an advocacy group for low-income people.

Jenny Rejeske, a health policy analyst at the National Immigration Law Center, which represents immigrants, said: “It is unduly harsh to terminate coverage while there are still technical problems with the federal system for verifying citizenship and immigration status. And there has not been adequate notice to people who speak languages other than English and Spanish.”

Florida leads the list of states whose residents are losing coverage because of immigration and citizenship issues, with 35,100. Federal officials said they were ending coverage for 19,600 people in Texas, 6,300 in Georgia, 5,300 in North Carolina, 5,200 in Pennsylvania, 4,000 in Illinois and 2,400 in New Jersey. The numbers released on Monday are for 36 states using the federal insurance marketplace. They do not include terminations in California, New York and other states running their own insurance exchanges.

Federal subsidies for the purchase of private insurance are a cornerstone of the Affordable Care Act. More than eight out of 10 people who selected health plans through the exchanges from October through mid-April were eligible for subsidies, including income tax credits. But in many cases, the government could not verify the incomes people reported when they applied for subsidized insurance.

This does not mean that they provided false information or were ineligible for assistance. The government tried to verify incomes by checking 2012 tax return information, but consumers may have switched jobs or received pay raises since filing those returns. As a result, officials said, the information in their applications may not match the data in federal files or in sources available to the government.

Mr. Slavitt said that on May 30 there were roughly 1.2 million households (and a total of 1.6 million people) with “data-matching issues.”

Since then, the government said, it has closed cases for 467,000 households with data discrepancies, and 430,000 cases are “currently in the process of being resolved.”

“There are still about 279,000 households with unresolved income-related data-matching issues that haven’t sent in supporting information, representing 363,000 individuals,” Mr. Slavitt said. They will soon receive letters from the government asking for proof of income, and if they do not reply by Sept. 30, they may lose some or all of their subsidies.

They would still be eligible for coverage, but in many cases could not afford it. In some cases, they would also have to repay some or all of the subsidies they received.

It is also possible that some people could receive larger subsidies if their incomes are lower than what they expected when they applied.

(A version of this article appears in print on September 16, 2014, on page A18 of the New York edition with the headline: U.S. to End Coverage Under Health Care Law for Tens of Thousands.)

http://allplaninsurance.com

http://thewoodlandstxhealthinsurance.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