Two weeks ago, our federal government shutdown on the promise by House Republicans that they would continue to fund the government only if the ACA was repealed. However, the final, bipartisan agreement reached yesterday that brought the federal government shutdown to a close left the ACA fully intact. Infact, the bill that the President signed into law included just one, relatively small, ACA provision: The legislation calls for new procedures by which HHS must strengthen income verification for individuals applying for federal tax subsidies to help pay for premiums of health plans purchased on the insurance exchanges.
Under the rule, HHS still would require applicants' income be verified against their IRS and Social Security records, and when that cannot be achieved, checked against employer records submitted to Equifax. The rule also allows state exchanges to check a statistically valid sample of applicants in cases where an applicant claims income more than 10% below what IRS and Social Security records show, and where there is no Equifax data ("The Economy Hub," Los Angeles Times, 10/16).
Despite two weeks of intensive, 24/7 repairs, healthcare.gov remains badly broken. This is especially problematic for states whose have chosen to let the federal government run their exchanges. Many media outlets have also reported that the technical glitches associated with open enrollment for state health exchanges may have received more attention if not for the shutdown.Perhaps now that the government has re-opened for business, the ACA will see the triumphant roll-out many supporters predicted.
The United Parcel Service (UPS) announced plans to drop 15,000 employee spouses from its healthcare plan. UPS said "rising medical costs, 'combined with the costs associated with the Affordable Care Act, have made it increasingly difficult to provide the same level of health care benefits to our employees at an affordable cost.'" (Washington Times, 8/22.) UPS spokesman Andy McGowan says the company expects the move to save $60 million a year.
CNBC notes that according to a recent Towers Watson survey, "mid- to large-sized companies overwhelmingly expect health-care costs to increase under Obamacare--and most are eyeing possible changes to their health insurance offerings because of a looming excise tax for pricier plans under the health-care reform law." In fact, the survey revealed that 40 percent of the 400+ companies surveyed said they will be changing the design of their insurance plans in 2014. Nearly 60 percent of those companies see the state health insurance Marketplaces as a possible way to control costs by shifting the work of insuring their employees onto the Marketplaces in the future.
In response to the UPS announcement, FedEx Corp. "isn't travelling the same route as delivery competitor UPS when it comes to trying to cut out health benefits for spouses and other family members. (Pittsburgh Business Times, 8/22.)
Many individuals and small businesses will be eligible for premium subsidies for health insurance purchased through Obamacare's online Marketplaces, starting October 1. As part of the eligibility process, Marketplaces must verify the income of consumers by using tax filing and Social Security data to verify household income.
Here's how it will work. When an individual applies for health insurance through an online Marketplace, she will be asked to verify her projected household income. That inputted data will then be verified with information available through the Internal Revenue Service (IRS) and Social Security Administration (SSA). If the data submitted by the individual cannot be verified through these avenues, additional wage information will be compared from employers via Equifax, if available.
State-based Marketplaces, meaning states that have set up and will independently administer their own health insurance Marketplace, “may choose to request additional documentation from a statistically-significant sample of the group of individuals in only one specific situation: when the Marketplace has IRS data, the application filer inputs projected annual household income that is more than ten percent below IRS and SSA data, Equifax data is unavailable, and the individual does not provide a reasonable explanation for the inconsistency between the attestation and IRS and SSA data.” (CMS FAQs.)
Federally-facilitated Marketplaces however, (that is, Marketplaces that will be run by the federal government because the state either refused to do it themselves, or elected to have a federally-run Marketplace) will require 100% of applicants applying for premium subsidies to provide additional documentation "with no exceptions."
Online Profile
HHS Secretary Sebelius announced Monday that consumers can now open personal healthcare accounts online at healthcare.gov in anticipation of the innaugural October 1 open enrollment for plans offered through state health insurance exchanges. Starting in September, you can begin comparing plans side-by-side through the online marketplace in your state.
The new personal account information is available only in English, for the time being. But HHS stated that personal account will be coming soon to the Spanish-language marketplace, at cuidadodesalud.gov.
The new online insurance marketplaces will be geared to people who don't have coverage through their jobs, most of whom will be eligible for tax credits to help pay their premiums. Insurance benefits take effect Jan. 1. That's also when the law will require most Americans to have health insurance or face fines. In return, insurers will be barred from turning away people with medical problems, often referred to as preexisting conditions. The administration hopes to sign up at least 7 million uninsured people next year.
Marketplace Checklist
In addition to creating your online profile, you can also answer a few simple questions about your current health insurance status in order to generate a personalized "Marketplace Checklist." This checklist will provide you with information about how to get ready for open enrollment and allow you to gather all the necessary information to hit the ground running in October.
Still don't understand what a health insurance exchange is? Don't worry! The government has also launched training videos and infographics to further help Americans understand the exchanges.
Individual Marketplace
Small Business Call Center
HHS also launched a special call center on Monday for small businesses, at 800-706-7893. Small businesses will have access to a separate marketplace, and may also be eligible for tax credits.
Learn more about how your small business can provide coverage through Obamacare by watching this short video!
In 168 days when open enrollment opens for the first time on Covered California (the state's health benefit exchange), California's children will get expanded opportunities for better dental health. Covered California has contracted with six participating dental insurers to provide stand-alone coverage for children's dental services. This means that these dental plans (with the exception of Health Net) are priced separately and do not require the additional purchase of a regular health insurance plan. The participating insurers are:
Anthem Blue Cross of California
Blue Shield of California
Delta Dental of California
Health Net
LIBERTY Dental Plan of California
Premier Access Dental and Vision
Depending on where the child lives, children will be eligible to be signed up for PPO, an in-network only PPO, and an HMO dental plan.
The Dental Preferred Provider Organization (DPPO) -- a wide variety of provider choice, including coverage for some out-of-network services.
The Dental Exclusive Provider Organization (DEPO) -- like DPPO, but without coverage for out-of-network services.
The Dental Health Maintenance Organization (DHMO) -- limits coverage to dental providers within one's network, and generally requires a referral for a specialist.
The plans offered will provide two types of payment options. One option requires a higher premium, but lower out-of-pocket costs. The second option offers lower premium rates, but higher than average out-of-pocket costs. Therefore depending upon how much the family anticipates needing dental services for a child, they can choose the actuarial value plan that best fits their particular situation.
For a complete break-down of plan pricing by region, take a look at this report published by Covered California last month.
On what feels like the eve of full healthcare reform implementation, many news sources have verified delays to certain provisions of the ACA. On Friday, the Obama administration quietly released a 602-page final regulation that included several delays not yet made public. In fact, the Washington Post's Wonkblog reported that the word "delay" turned up 45 times in that document.
Here are the most notable delays:
Delayed until 2015: The employer mandate, requiring employers with 50+ full-time employees to provide the requisite amount of healthcare coverage under the new law.
Delayed until 2015: State-run marketplaces (of which there are 17) will not have to verify consumers' claims that they do not receive health insurance from their employer.
Explanation: Anyone who receives an affordable offer of health insurance from their employer, regardless of their annual income, does not qualify for a federal tax credit. Originally the federal government assured states they would assume the burden of verifying applicant claims of not receiving employer-sponsored insurance. As a result, many people who shouldn't qualify for tax subsidies may get them anyway. (This also happened during the roll-out of Medicare Part D, when some seniors who should not have received low-income subsidies got them anyway.)
Delayed until 2015: Consumers will be allowed to self-report income without full federal oversight during 2014.
Explanation: Originally, CMS had requested the government set up a system to verify income data for anyone who reported their income was 10% lower than what federal data said they earned. (This can happen to people who lose their jobs or those who game the system.) Now, the federal government has stated that they will only double-check a "statistically significant" number of applicants with large income discrepancies. This provision will affect all 50 states.
Delayed until 2015: Electronic notices for Medicaid
Explanation: State Medicaid programs now have an additional year to roll out electronic notices of, among other things, what tax subsidy an individual applicant is eligible to receive. We've all seen the waffling Medicaid Expansion decisions for months...apparently this waffling deserves a one-year reward.
Delayed at least until 2015:A computer system glitch (that will reportedly take at least a year to fix) will limit the penalties that the law says insurers can charge smokers.
Premiums hikes do to tobacco-use penalties would have made insurance coverage for some smoker unaffordable. Saved by the glitch -- but only if you're elderly. Apparently the computers can't process premium hikes for a 65-year old smoker, but may be able to handle penalties for 21-year old smokers without a problem, since penalties for younger smokers may be 3x less than those for older smokers.
Example from SF Gate: "Premiums for a standard "silver" insurance plan would be about $9,000 a year for a 64-year-old non-smoker, according to the online Kaiser Health Reform Subsidy Calculator. That's before any tax credits, available on a sliding scale based on income. For a smoker of the same age, the full 50 percent penalty would add more than $4,500 to the cost of the policy, bringing it to nearly $13,600. And tax credits can't be used to offset the penalty."
