Second Chance Open Enrollment Through April 30 For ObamaCare: How Will Employers React If a Second Chance Enroller Triggers an Employer Mandate Penalty?

February 23, 2015 at 9:04 am | Posted in Affordable Care Act, Health Care | Leave a comment
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The Hill reported today that the Obama administration (through CMS) will hold a second enrollment period for ObamaCare this year to give people a chance to avoid a new tax penalty for going without insurance. The enrollment period will run from March 15 to April 30, at the height of tax filing season, officials said. The announcement does not address the issue of whether any form of transitional relief would be available to a large employer who, until now, may have avoided a penalty under the employer mandate because of the failure of an employee to sign up for ACA coverage and possibly receive a premium subsidy. Arguably, such an employer would now be exposed again since employees lacking coverage will have another bite at the ACA health coverage subsidy apple.

Congressional Democrats and advocacy groups had been pushing for the new enrollment period, arguing that millions of people are still unaware of the penalty and should be able to sign up for ObamaCare once they learn of it. “Our intention in doing this is not to increase numbers for numbers sake, it’s to make sure that if there were people who were unaware of the fee that they aren’t disadvantaged by that,” Andy Slavitt, the Centers for Medicare and Medicaid Services’ deputy administrator, said on a call with reporters. The administration estimates that up to 6 million people will likely be forced to pay the fine for not having insurance during this year’s tax season, marking the first time that the penalty will be in effect. Officials said that they do not have an estimate for how many people will take advantage of the new enrollment period.
People signing up now will still have to pay a penalty for lacking insurance in 2014. Anyone who was uninsured last year will be hit with penalties of either $95 or 1 percent of their income — whichever is higher. That fine will spike this year to $325 or 2 percent of their income. Officials said that the new period is a one-year-only occurrence. “Our intention is that this is one year only for people who have not been in the communication loop around the tax penalty,” Slavitt said.
Separately, the administration announced that there had been an error on a tax return form for people with coverage under ObamaCare, causing some tax credits to be calculated either too high or too low. Officials said the problem affects around 50,000 people who have already filed their taxes, and that they are being contacted to correct the problem.
A link to the announcement can be found here: CMS Announces Special Enrollment Period for Tax Season

Democratic Pressure Builds to Reopen ACA Exchange Enrollment Through April

February 19, 2015 at 10:33 am | Posted in Affordable Care Act, Health and Human Services | Leave a comment
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The publication The Hill reported today that pressure is building on the Obama administration to give uninsured people a second chance to sign up for ObamaCare before they are required to pay a fine of $325 or 2% of their income, whichever is greater, during next year’s tax season. Democrats and several advocacy groups argue that people without insurance don’t realize they’re in danger of taking a significant economic hit.

“Millions upon millions of people are unaware about these penalties,” Ron Pollack, the executive director of the nonprofit group Families USA, said in a briefing Wednesday. The first time people will actually pay the fine is in this coming tax season. Just one-third of people without health insurance said they were aware of the healthcare law’s penalty in a March 2014 poll by the Kaiser Family Foundation. The administration estimates that as many as 6 million people will be forced to pay up this spring.

The pressure on the administration is coming from advocacy groups, Democratic lawmakers and states that are extending or adding to their enrollment periods. Minnesota on Wednesday became the second state to add a grace period through the end of tax season in April. California and New York – the two largest state exchanges – are also mulling an extension, as is Kentucky, state officials said Wednesday. California will decide by early next week whether to create the special period – an idea that the state’s health secretary said Wednesday that she supports. If the administration doesn’t provide another enrollment period, it could create a situation where residents of some states have more time to avoid the tax, while people on the 37-state federal exchange do not.

The administration hasn’t ruled out adding the enrollment period, and HHS Secretary Sylvia Mathews Burwell said Wednesday that she plans to make a decision by next Friday. Sen. Tammy Baldwin (D-Wis.) is leading a group of 10 Democratic senators this week who wrote a letter to Burwell urging a new period. Separately, Sander Levin (D-Mich.), the top Democrat on the Ways and Means Committee, signed a letter with two other Democrats to “strongly urge” the administration to give extra time.

 

2015 ACA Open Enrollment: More Than 6 Million Receive Premium Tax Credit

February 10, 2015 at 12:37 pm | Posted in Affordable Care Act, Health and Human Services, Health Insurance Marketplace | Leave a comment
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Yesterday the U.S. Department of Health and Human Services (HHS) released  a report outlining the impact of advanced premium tax credits on premiums in the Health Insurance Marketplaces. Almost 6.5 million individuals in the 37 states using the HealthCare.gov platform are estimated to qualify for an average of $268 per person/month in advanced premium tax credits. Among consumers who are signed up for 2015 coverage to date in the 37 HealthCare.gov states, 8 in 10 could choose a plan with a premium of $100 or less after tax credits, based on available options.

A copy of the full HHS announcement can be found here:

Almost 6.5 million consumers qualify for an average tax credit of $268 per month through the Health Insurance Marketplaces

The D.C. Circuit Court of Appeals Agrees to Rehear ACA State/Federal Exchange Argument: The Obama Administration Gets a Second Bite at the Apple

September 4, 2014 at 12:47 pm | Posted in Affordable Care Act, Health Insurance Exchanges | Leave a comment
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The D.C. Circuit Court of Appeals has agreed to rehear argument and revisit its earlier ruling striking down Affordable Care Act (ACA) subsidies issued through federal exchanges as opposed to state exchanges. The announcement of the second hearing is a procedural victory for the Obama administration, which suffered a defeat in late July when a three-judge panel voted 2-1 that subsidies issued through federal exchanges were not allowed under the ACA. The two judges voting to strike down the subsidy language were appointed by a Republican President. A decision by the full D.C. appellate court (11 judges), in which Democratic appointees outnumber Republican appointee, is scheduled for oral argument on December 17.

 

Although First in Universal Healthcare Requirement…Massachusetts Remains Near Last in a Functioning Website/Exchange

July 14, 2014 at 11:44 am | Posted in Affordable Care Act, Health Insurance Exchanges, Health Insurance Marketplace | Leave a comment
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As reported in the July 10, 2014 article from the Associated Press that follows, frustration abounds on Beacon Hill as the state is still hoping for a soon to be operational health insurance exchange/marketplace.

By BOB SALSBERG, Associated Press:

BOSTON (AP) Software ordered by Massachusetts to fix its hobbled health care exchange passed initial tests, renewing hopes that the state could finally have a fully operational website by year’s end, officials said Thursday.

The breakdown dramatically slowed the state’s transition to the federal Affordable Care Act from its own first-in-the-nation universal health insurance law that provided a model for President Barack Obama’s plan.

Massachusetts severed ties earlier this year with the lead contractor on its health exchange, CGI Group, and has been forced to shuffle more than 200,000 of its residents into temporary Medicaid coverage.

In May, state officials unveiled a “dual-track” approach that called for buying software that has powered insurance marketplaces in other states while also laying the groundwork for a switch over to the federal government’s health insurance market, should that be necessary.

Maydad Cohen, a special assistant to Gov. Deval Patrick, told the Massachusetts Health Connector board that the software cleared several key tests after its initial release last month, prompting federal officials to authorize the state to continue pursuing its current strategy.

A final decision on whether to go forward with the software solution is expected early next month following the rollout of an enhanced version of the program.

Cohen said the goal was a fully functional exchange before the next ACA enrollment period beginning Nov. 15.

“I don’t know where we are going to be at open enrollment right now, but I am increasingly, cautiously optimistic about our ability to deliver the product,” Cohen told reporters after briefing the board.

The total cost to taxpayers for the website breakdown remained unclear.

The state initially estimated the cost of the dual-track approach at $121 million. Officials said they would not be able to produce a final cost estimate until it finalized contract negotiations with Optum, a health care technology firm that was retained by the state.

Cohen said state officials hope the federal government agrees to pay the full tab for repairs. A separation agreement reached with CGI calls for paying the Montreal-based firm an additional $35 million on top of the $17 million the state already had paid toward an original $89 million contract.

The state also had paid out $138 million in fees for medical services through June 30 for the 237,000 residents forced into “provisional” Medicaid coverage because the connector was unable to determine their eligibility for ACA-compliant programs, Secretary of Administration and Finance Glen Shor said Thursday.

That total was before federal reimbursement, and Shor insisted the overall costs would not have been much higher had the state been able to enroll more people into permanent coverage. Officials remain confident that all residents will be moved off temporary coverage by next year.

Massachusetts has been given a waiver from most requirements of the federal law until Dec. 31.

Supreme Court Strikes Down ACA Contraception Mandate in Application to Family Owned Companies

June 30, 2014 at 12:06 pm | Posted in Affordable Care Act | Leave a comment
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This morning the Supreme Court announced, in a 5-4 decision, that the ACA’s contraception mandate violated the constitution’s religious protection clause in regards to its application to family or closely held corporation. The court took pains to say that its ruling did not reach publicly traded companies and that it was limited to only the issue of contraception. Justice Alito, writing for the majority, opined that closely held corporations cannot be required to provide contraception coverage under the ACA if they had religious objections. The IRS defines a closely held corporation as: one that has more than 50 percent of the value of its outstanding stock owned (directly or indirectly) by five or fewer individuals and is not a personal service corporation. “Protecting the free-exercise rights of closely held corporations thus protects the religious liberty of the humans who own and control them,” wrote Alito.

A copy of the opinion can be found here: http://www.supremecourt.gov/opinions/13pdf/13-354_olp1.pdf

IRS Says Employer Payment Plan for Marketplace Individual Coverage Triggers $36,500 per Employee per Year Penalty

May 27, 2014 at 3:25 pm | Posted in Affordable Care Act, Health Insurance Marketplace, IRS | Leave a comment
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Last week the IRS released the FAQS below which are intended to disincent employers from directing employees to a Marketplace/Exchange with the promise of reimbursing the employee for any premiums used for Exchange coverage since the “employer payment plan” is considered a “group health plan” that violates the ACA group health plan reforms.   Note that the first FAQ concludes:

“Consequently, such an arrangement fails to satisfy the market reforms and may be subject to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee) under section 4980D of the Internal Revenue Code.”

Employer Health Care Arrangements

Q1. What are the consequences to the employer if the employer does not establish a health insurance plan for its own employees, but reimburses those employees for premiums they pay for health insurance (either through a qualified health plan in the Marketplace or outside the Marketplace)?

Under IRS Notice 2013-54, such arrangements are described as employer payment plans. An employer payment plan, as the term is used in this notice, generally does not include an arrangement under which an employee may have an after-tax amount applied toward health coverage or take that amount in cash compensation. As explained in Notice 2013-54, these employer payment plans are considered to be group health plans subject to the market reforms, including the prohibition on annual limits for essential health benefits and the requirement to provide certain preventive care without cost sharing. Notice 2013-54 clarifies that such arrangements cannot be integrated with individual policies to satisfy the market reforms. Consequently, such an arrangement fails to satisfy the market reforms and may be subject to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee) under section 4980D of the Internal Revenue Code.

Q2. Where can I get more information?

On Sept. 13, 2013, the IRS issued Notice 2013-54, which explains how the Affordable Care Act’s market reforms apply to certain types of group health plans, including health reimbursement arrangements (HRAs), health flexible spending arrangements (health FSAs) and certain other employer healthcare arrangements, including arrangements under which an employer reimburses an employee for some or all of the premium expenses incurred for an individual health insurance policy.

DOL has issued a notice in substantially identical form to Notice 2013-54, DOL Technical Release 2013-03, and HHS will shortly issue guidance to reflect that it concurs with Notice 2013-54. On Jan. 24, 2013, DOL and HHS issued FAQs that addressed the application of the Affordable Care Act to HRAs.

HHS Claims that Quality Improvements and the Affordable Care Act Saved 15,000 Lives and $4 Billion in Health Spending During 2011 and 2012

May 7, 2014 at 10:43 am | Posted in Affordable Care Act, Health and Human Services, Health Care, Medical, PPACA, Regulations | Leave a comment
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HHS announced today that new preliminary data show an overall 9% decrease in hospital acquired conditions nationally during 2011 and 2012. National reductions in adverse drug events, falls, infections, and other forms of hospital-induced harm are estimated to have prevented nearly 15,000 deaths in hospitals, avoided 560,000 patient injuries, and approximately $4 billion in health spending over the same period.

HHS claims that the Affordable Care Act is also helping reduce hospital readmissions. After holding constant at 19% from 2007 to 2011 and decreasing to 18.5% in 2012, the Medicare all-cause 30-day readmission rate has further decreased to approximately 17.5% in 2013. This translates into an 8% reduction in the rate and an estimated 150,000 fewer hospital readmissions among Medicare beneficiaries between January 2012 and December 2013.

A complete copy of the HHS announcement can be found here: http://www.hhs.gov/news/press/2014pres/05/20140507a.html

White House Announces More Than Seven Million Have Signed Up for Health Care through Exchange/Marketplace

April 1, 2014 at 4:20 pm | Posted in Affordable Care Act | Leave a comment
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The following was posted this afternoon on the White House webpage:

Today, the White House announced that more than 7 million Americans signed up for affordable care through the Health Insurance Marketplace during the Affordable Care Act’s open enrollment, which ended on March 31.

This number announced during Press Secretary Jay Carney’s briefing, means that millions of Americans across the country now have access to quality, affordable care. As numbers continue to come in from states running their own Marketplace, that number will continue to rise.

Later today, President Obama will deliver a statement on the Affordable Care Act in the Rose Garden. You can watch it on WhiteHouse.gov/Live at 4:15 p.m. ET.

Though HealthCare.gov got off to a rocky start in October, the open enrollment period ended with soaring interest — including a record-breaking 4.8 million visits to HealthCare.gov, and around 2 million calls to CMS call centers. Throughout this weekend, Americans across the country were literally lined up around the block at local enrollment centers.

It’s important to remember that 7 million represents only part of the total number of people who have received coverage under the Affordable Care Act: millions more have been covered by state Medicaid expansions, and around 3 million Americans under 26 are now covered under their parents’ plans.

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