WASHINGTON — The fierce struggle to enact and carry out the Affordable Care Act was supposed to put an end to 75 years of fighting for a health care system to insure all Americans. Instead, the law’s troubles could make it just a way station on the road to another, more stable health care system, the shape of which could be determined on Election Day.
Seeing a lack of competition in many of the health law’s online insurance marketplaces, Hillary Clinton, President Obama and much of theDemocratic Party are calling for more government, not less.
The departing president, the woman who seeks to replace him and nearly one-third of the Senate have endorsed a new government-sponsored health plan, the so-called public option, to give consumers an additional choice. A significant number of Democrats, for whom Senator Bernie Sanders spoke in the primaries, favor a single-payer arrangement, which could take the form of Medicare for all.
Donald J. Trump and Republicans in Congress would go in the direction of less government, reducing federal regulation and requirements so insurance would cost less and no-frills options could proliferate. Mr. Trump would, for example, encourage greater use of health savings accounts, allow insurance policies to be purchased across state lines and let people take tax deductions for insurance premium payments.
ST. PAUL, Minn. (AP) — Minnesota’s top health insurance regulator says the state’s individual market is in “an emergency situation” amid big rate increases for next year.
Department of Commerce Commissioner Mike Rothman said Friday that the five companies offering plans through the state’s exchange or directly to consumers were prepared to leave the market for 2017. He said big rate increases were the tradeoff to convince all but one company to remain for now.
Rate increases finalized this week range from a 50 percent average hike for HealthPartners plans to a 67 percent jump on average on UCare.
By Susan K. Livio | NJ Advance Media for NJ.com
on September 12, 2016 at 8:18 PM, updated September 13, 2016 at 8:38 AM
TRENTON — Faced with “a deteriorating financial condition,” another health insurance carrier is pulling out of New Jersey’s health exchange marketplace created under the Affordable Care Act, forcing 35,000 policy holders to find a new plan in 2017, the state’s top insurance official announced Monday night.
Health Republic Insurance of New Jersey will serve customers through the end of the year, state Department of Banking and Insurance Commissioner Richard Badolato said.
The state is working out a “rehabilitation” plan that preserves the carrier’s financial assets so medical providers will be reimbursed for the care they provide consumers for the remainder of the year, Badolato said in a statement late Monday.
“We will also be assisting individual consumers as they transition to a new plan during the open enrollment period this fall,” Badolato said. “Similarly, we will work with small employers as they seek replacement plans for their businesses.”
Eight of the states that will determine the Senate majority in November are likely to see significant reductions in the number of insurers participating in ObamaCare marketplaces.
The likely departures of insurers in Illinois, Wisconsin, Florida, Pennsylvania, Ohio, North Carolina, Arizona and Missouri are pushing the healthcare law toward the center of some of the most competitive Senate races in the country.
GOP strategists say Obama-Care’s troubles this year are morphing into a perfect storm for their candidates, providing a boost in a year when the party is defending 24 Senate seats.
“It feels like there’s a sleeping giant that’s about to awaken on the campaign trail,” veteran Republican strategist Ron Bonjean said. “It really does seem like an easy target, an easy layup for Republicans to score points.”
Health insurers have been fleeing the marketplaces over the last year, citing steep financial losses. The departures, which have included industry leaders like UnitedHealth Group and Aetna Inc., are cutting into the choices people have when selecting ObamaCare plans.
Next year, exactly half of all states are expected to see fewer ObamaCare options in at least one county, according to data compiled by the Kaiser Family Foundation.
An analysis of the Kaiser data by The Hill found that the exits from ObamaCare align with some of the biggest battlegrounds for Senate Republicans this year.
Every county in Ohio, a crucial swing state, is on track to lose at least two insurers compared to last year. All of the counties in Pennsylvania, Indiana, Missouri, Arizona and Illinois are also expected to lose at least one option, according to Kaiser.
There’s something about Obamacare that really shines a light on the stupid. And by that I mean stupid politicians, stupid “experts,” and even regular – but stupid – Americans. And in case you missed it, the last few weeks have presented us, and the presidential candidates, with more solid evidence of ACA-related stupidity than usual. Let’s look at the top three contenders on the Obamacare Stupid Bowl ’16:
First, we now know that Obamacare enrollment has fallen short by 24 million people. The real number of enrolled Americans in ACA plans is 11.1 million. Making matters worse is the fact that a major chunk of the people not signing up are the younger and healthier Americans the ACA’s architects were foolishly relying on to help absorb the costs from older and sicker enrollees. This is the continuing development that many call the “Obamacare Death Spiral.”
Second, so many Insurance companies are curtailing their participation in Obamacare exchanges that 31 percent of U.S. counties are likely to have just one insurance company option for health coverage by next year. That’s what we call a monopoly. And in case you don’t know how dangerous monopolies can be in health care, Google the words “Mylan” and “EpiPen” when you get a chance.
Citing the financial unsustainability of Obamacare, both the insured and insurers are fleeing Obamacare in increasing numbers, leaving President Obama’s takeover of the nation’s healthcare system on the verge of collapse.
The administration has claimed Obamacare — officially designated the Affordable Care Act — to be a great success, insisting that 20 million previously uninsured Americans now have insurance. But according to a report at The Guardian, that “success” comes at the expense of all the features that were supposed to make the law sustainable.
President Obama and his cohorts imagined that since Obamacare was to be compulsory, millions of healthy young Americans would immediately sign up, and the massive influx of cash paid into the system as insurance premiums would help pay for the higher costs in care doled out to older, sicker enrollees.
Jayne O’Donnell and Tony Leys, USA TODAY Network8:46 p.m. EDT September 1, 2016
Many of next year’s premium rate increases on theAffordable Care Act exchanges threaten to surpass the high and wildly fluctuating rates that characterized the individual insurance market before the health law took effect, interviews with insurance regulators and records show.
With dramatic drops in insurance company participation on the exchanges for some states, decreased competition and other factors are leading to often jarring rate hikes. Some of the states that are facing what are likely among the biggest increases this year — Tennessee, Arizona and North Carolina — were among those the Urban Institutereported in May had the biggest increases last year.
“The reality is, it’s all very justified, unfortunately,” Iowa insurance commissioner Nick Gerhart said Thursday of the premium increases he approved this week of 19% to 43% for about 70,000 Iowans who buy their own policies.
Gerhart warned consumers in a rate hearing in July that if he rejected insurers’ proposed premium increases for 2017, the carriers would likely decline to sell policies in the state. No carriers made an explicit threat to leave Iowa, but the implication was clear, he says: “It gives you less room to maneuver.” Iowa law, he said, requires him to judge proposed premium increases on whether experts find them to be justified by carriers’ projected costs
As other state insurance commissioners gradually sign off on insurers’ rate requests — which should all be decided within a month — many consumers are learning what’s in store for 2017.
State insurance officials say they are feeling pressure to approve large ObamaCare premium increases to prevent more insurers losing money from dropping out of the market altogether.
Tennessee’s insurance commissioner, Julie Mix McPeak, this week announced the approval of premium hikes of 62 percent, 46 percent and 44 percent, respectively, for the three insurers on the state’s marketplace.
She said her department’s actuaries had found the rate increases to be justified.
“I didn’t feel like I had any choice but to approve those rates when it came back to be actuarially justified,” she said.
Tennessee is unlikely to be alone in authorizing premium hikes, either. In Maryland, officials are expecting a hike.
“There are going to be significant increases in the individual market,” said Al Redmer, the insurance commissioner in Maryland, where the rates are still being reviewed.
It is unclear how many other states may allow large premium hikes.
An early estimate from ObamaCare analyst Charles Gaba finds that for nine states the average approved premium increase for next year is 27.6 percent.
My son has been paying $2,100 a month for one of these individual insurances. When his daughter broke her elbow, his wife had to call 13 physicians before finding one who would see an 11 year old child! This policy was a replacement for his policy of last year –which was just as bad– which the insurer dropped to join the Hackensack group only. Now he has been notified that this one is leaving NJ at the end of the year. He’s in business for himself and really doesn’t know what he is going to do. And, of course, before Obamacare he had a policy that they loved with much lower premiums. But what Obama really meant was “if you have a policy you like, you can (dream on) keep it.”
HARTFORD, Conn., Aug. 16 (UPI) — Healthcare insurer Aetna Inc. announced it will pull out of the Affordable Care Act individual public exchanges in 11 states after millions of dollars in losses.
In a statement Monday, Aetna said it will remain in Delaware, Iowa, Nebraska and Virginia, but will stop offering policies in 11 other states, beginning in 2017.
Reader asks ,please don’t forget the ACA excise taxes from 2020~…. that’s another 40% on platinum level health benefits like those our teachers, police and fire currently enjoy. They either all need to be downgraded to bronze level health benefits or taxpayers will bear the brunt of the 40% tax on $25,000 family plans, i.e. an additional $10,000 a year per Village and BOE employee with a platinum family plan. Who pays for that?
Ridgewood NJ, On December 18, 2015, Congress passed and the President signed a two-year delay of the 40 percent excise tax on high-cost employer-sponsored health plans, also known as the “Cadillac Tax.” This delay was part of a year-end government funding package and changes the effective date from 2018 to 2020. While the tax was originally non-tax deductible, the December 2015 changes make it tax deductible for employers who pay it.
No regulations have been issued to date. In February and July 2015, the Internal Revenue Service (IRS) issued notices covering a number of issues concerning the Cadillac Tax, and requested comments on the possible approaches that could ultimately be incorporated into proposed regulations.
What it is/fee duration
Permanent, annual tax beginning in 2020 on high-cost employer-sponsored health coverage.
Purposes
Reduce tax preferred treatment of employer provided health care
Reduce excess health care spending by employees and employers
Help finance the expansion of health coverage under the Affordable Care Act (ACA)
Amount
The tax is 40% of the cost of health coverage that exceeds predetermined threshold amounts.
Cost of coverage includes the total contributions paid by both the employer and employees, but not cost-sharing amounts such as deductibles, coinsurance and copays when care is received.
For planning purposes, the thresholds for high-cost plans are currently $10,200 for individual coverage, and $27,500 for family coverage.
These thresholds will be updated before the tax takes effect in 2020 and indexed for inflation in future years.
The thresholds will also be increased:
If the majority of covered employees are engaged in specified high-risk professions such as law enforcement and construction, and
For group demographics including age and gender.
For pre-65 retirees and individuals in high-risk professions, the threshold amounts are currently $11,850 for individual coverage and $30,950 for family coverage. These amounts will also be indexed before the tax takes effect.
Who calculates and pays
Insured: Employers calculate and insurers pay
Self-funded: Employers calculate and “the person who administers the plan benefits” pays
HSAs and Archer MSAs: Employers calculate and employers pay
How a group health plan’s cost is determined
The tax is based on the total cost of each employee’s coverage above the threshold amount.
The cost includes contributions toward the cost of coverage made by employers and employees.
The statute states that costs of coverage will be calculated under rules similar to the rules for calculating COBRA premium.
How the tax will be paid
Forms and instructions for paying the tax are not yet available.
Tax implications
Based on the December 2015 changes, Cadillac Tax payments will be deductible for federal tax purposes.
Applicable types of coverage
Insured and self-insured group health plans (including behavioral, and prescription drug coverage)
Wellness programs that are group health plans (most wellness programs)
Health Flexible Spending Accounts (FSAs)
Health Savings Accounts (HSAs), employer and employee pre-tax contributions*
Health Reimbursement Accounts (HRAs)*
Archer Medical Savings Accounts (MSAs), all pre-tax contributions*
On-site medical clinics providing more than de minimis care*
Executive Physical Programs*
Pre-tax coverage for a specified disease or illness
Hospital indemnity or other fixed indemnity insurance
Federal/State/Local government-sponsored plans for its employees
A mid rising drug and health care costs and roiling market dynamics, the spokesperson for the nation’s health insurers is predicting substantial increases next year in Obamacare premiums and related costs.
Without venturing a specific percentage increase, Marilyn Tavenner, the president and CEO of America’s Health Insurance Plans (AHIP), said in an interview with Morning Consult that the culmination of market shifts and rising health care costs will force stark increases in health insurance rates in the coming year.
“I’ve been asked, what are the premiums going to look like?” she said. “I don’t know because it also varies by state, market, even within markets. But I think the overall trend is going to be higher than we saw previous years. That’s my big prediction.”
If Tavenner is right, Obamacare will jump dramatically—last year’s premium for the popular silver-level plan surged 11 percent on average. Although Tavenner didn’t mention deductibles, in 2016, some states saw jumps of 76 percent, while the average deductible for a 27-year-old male on a silver plan was 8 percent.
UnitedHealth, the nation’s biggest health insurer, will cut its participation in public health insurance exchanges to only a handful of states next year after expanding to nearly three dozen for this year.
CEO Stephen Hemsley said Tuesday that the company expects losses from its exchange business to total more than $1 billion for this year and last. He added that the company cannot continue to broadly serve the market created by the Affordable Care Act’s coverage expansion due partly to the higher risk that comes with its customers.
The state-based exchanges are a key element behind the Affordable Care Act’s push to expand insurance coverage. But insurers have struggled with higher than expected claims from that business.
UnitedHealth Group Inc. said it now expects to lose $650 million this year on its exchange business, up from its previous projection for $525 million. The insurer lost $475 million in 2015, a spokesman said.
Hundreds of thousands people will lose their insurance plans as a raft of health insurance cooperatives (CO-OPs) created by the Affordable Care Act will cease operations. Just last week, CO-OPs in Oregon, Colorado, Tennessee and Kentucky announced that they would be winding down operations due to lower than expected enrollment and solvency concerns (although the one in Colorado is suing the state over the shutdown order). They join four other CO-OPs that have announced that they would be closing their doors. In total, only 15 out of the 23 CO-OPs created by the law remain. These closures reveal how ill-advised this aspect of the ACA was both in terms of lost money and the turmoil for the people who enrolled in them. The eight that have failed have received almost $1 billion in loans, and overall CO-OPs received loans totaling $2.4 billion that might never get paid back. In addition, roughly 400,000 people will lose their plans.
Sources: Sabrina Corlette et al. “The Affordable Care Act CO-OP Program: Facing Both Barriers and Opportunities for More Competitive Health Insurance Markets,” The Commonwealth Fund, March 12, 2015; Erin Marshal, “8 Things to Know About Insurance CO-OP Closures,” Becker’s Hospital Review, October 20, 2015. Created using Tableau.
Notes: Hawaii and Alaska not shown. Neither state had a CO-OP. CoOportunity Health served both Iowa and Nebraska.
Proponents of the CO-OPs believed that they would be able to offer lower premiums than for-profit insurers because they did not have the same profit motive, but even non-profit insurers cannot operate at a financial loss indefinitely. When they were created, these CO-OPs had no customers, no experience in setting premiums, no networks and limited capital. The government tried to subsidize the early period of uncertainty by disbursing loans to help with startup and solvency issues, and money from other provisions like risk corridors would dampen losses in the initial years. Lower than expected payments from the risk corridors have exacerbated the issues facing some of these CO-OPs, who were counting on substantial payments to stay afloat. But this is hardly the only factor contributing to their struggles, some of them the product of other government policies like delaying employer mandate penalties and giving states the option to allow transitional policies through 2017. Some of these later developments could not have been anticipated, but many analysts, including Cato scholars, were skeptical about the prospects of CO-OPs from the beginning. Even some ACA supporters recognized the flaws inherent in the CO-OP design: Paul Krugman derided them as a “sham” and in a 2009 interview Professor Timothy Jost said could not see how a CO-OP “does anything to control costs.” There have been multiple warning signs that many CO-OPs were in trouble. Earlier this year The Centers for Medicare and Medicaid Services sent letters to 11 CO-OPs placing them on “enhanced oversight” due to financial concerns, and a 2014 report from the HHS Office of Inspector General found that “most of the 23 CO-OPs we reviewed had not met their initial program enrollment and profitability projections,” and that the government “had not established guidance or criteria to assess whether a CO-OP was viable or sustainable.”
These CO-OPs were not a good idea at inception and were always going to face many obstacles to success. Multiple changes to the law since they were established have exacerbated these problems, and already struggling CO-OPs have folded. Competition is indeed vital in health insurance markets, but the CO-OPs were a bad way to try to foster this competition. With these closures, billions of taxpayer dollars could be lost and hundreds of thousands of people will discover that the “if you like your plan, you can keep it” promise does not apply to them.
NEW YORK (TheStreet) — It’s time for the Affordable Care Act to join a long list of oxymorons. Why? Because rather like “military intelligence,” “cat proof,” “government organization,” and “simple calculus,” the law better known as Obamacare turns out to be an inherent contradiction. For a sizeable part of the population, anyway.
The ACA is just not affordable to a big chunk of those it was most meant to serve: The previously uninsured. In fact, many are worse off than before, according to a new study. That fact could also unravel part of the program’s foundation, which could be a problem for healthcare insurers.
“Many of the non-poor formerly uninsured are estimated to be worse off,” than without insurance, according to a September-dated working paper from the National Bureau of Economic Research titled “The Price of Responsibility: The Impact Of Health Reform On Non-Poor Uninsured.”
