Tag Archives: Individual Health Care Mandate

NY exchange scores F’s on some consumer features

The New York State of Health exchange lacks many of the features that other public Obamacare marketplaces, including Healthcare.gov, have added to make it easier for users to compare plans, according to a report released Tuesday by the Clear Choices Campaign, an advocacy group that seeks greater transparency in health care quality and pricing. Rather than just allowing users to compare premiums, for instance, some exchanges include tools that let users calculate their out-of-pocket costs and search for plans that cover their preferred drugs and providers. The scorecard accompanying the report gave New York an F in several categories. Although the pending repeal of the Affordable Care Act introduces uncertainty into the future of the Obamacare exchanges, a less standardized health insurance marketplace could increase the need for such comparison-shopping tools, said Joel White, president of the Clear Choices Campaign. White is also founder and president of the health care lobbying firm Horizon Government Affairs.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Senate Takes Major Step Toward Repealing Health Care Law

WASHINGTON — Senate Republicans took their first major step toward repealing the Affordable Care Act on Thursday, approving a budget blueprint that would allow them to gut the health care law without the threat of a Democratic filibuster.

The vote was 51 to 48. During the roll call, Democrats staged a highly unusual protest on the Senate floor to express their dismay and anger at the prospect that millions of Americans could lose health insurance coverage.

One by one, Democrats rose to voice their objections. Senator Maria Cantwell of Washington said that Republicans were “stealing health care from Americans.” Senator Ron Wyden of Oregon said he was voting no “because health care should not just be for the healthy and wealthy.”

The presiding officer, Senator Cory Gardner, Republican of Colorado, repeatedly banged his gavel and said the Democrats were out of order because “debate is not allowed during a vote.”

The final vote, which ended just before 1:30 a.m., followed a marathon session in which senators took back-to-back roll call votes on numerous amendments, an arduous exercise known as a vote-a-rama.

The approval of the budget blueprint, coming even before President-elect Donald J. Trump is inaugurated, shows the speed with which Republican leaders are moving to fulfill their promise to repeal President Obama’s signature domestic policy achievement — a goal they believe can now be accomplished after Mr. Trump’s election.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Muted Response From Health Lobby as Affordable Care Act Faces Repeal

WASHINGTON — The speed of Republican efforts to repeal the Affordable Care Act has stunned health industry lobbyists, leaving representatives of insurance companies, hospitals, doctors and pharmaceutical makers in disarray and struggling for a response to a legislative quick strike that would upend much of the American health care system.

The Senate is expected to take the first step by Thursday morning, approving parliamentary language in a budget resolution that would fast-track a repeal bill that could not be filibustered in the Senate. House and Senate committees would have until Jan. 27 to report out repeal legislation. Health insurance and health care for millions of Americans are at risk.

But far from reflecting the magnitude of the moment, the most prominent message from lobbyists that lawmakers saw in their first week back at work was a narrowly focused advertisement from the U.S. Chamber of Commerce demanding the repeal of “Obamacare taxes,” especially an annual fee imposed on health insurance companies to help pay for the expansion of coverage under the health law.

“More than 20 million people could lose their health insurance, and states could lose billions of dollars in Medicaid money,” said Kenneth E. Raske, the president of the Greater New York Hospital Association. But, he added, many health care executives “don’t want to get on the wrong side of the new administration or the Republican majority in Congress.”

Health care professionals are not totally silent, but industries that were integral to the creation of the Affordable Care Act in 2010 are keeping their voices down as Republicans rush to dismantle it. Some Republican lawmakers are openly fretting about their leaders’ repeal strategy, saying they must develop an Affordable Care Act replacement before they repeal it. Five Republican senators proposed on Monday to extend the deadline for drafting repeal legislation by five weeks, until March 3. One of the five, Senator Bob Corker of Tennessee, said the extra time would allow Congress and the Trump administration to “get the policy right” as they try to arrange a smooth transition to a new system of health coverage.

But the naysayers are getting no cover from a major lobbying and advertisement blitz like the ones that blanketed the airwaves in 2009 and 2010.

To block the repeal effort, said Senator Richard J. Durbin of Illinois, the No. 2 Senate Democrat, “we need two or three Republicans to join us.”

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Health Care Law Forces Businesses to Consider Growth’s Costs

When LaRonda Hunter opened a Fantastic Sams hair salon 10 years ago in Saginaw, Tex., a suburb of Fort Worth, she envisioned it as the first of what would eventually be a small regional collection of salons. As her sales grew, so did her business, which now encompasses four locations — but her plans for a fifth salon are frozen, perhaps permanently.

Starting in January, the Affordable Care Act requires businesses with 50 or more full-time-equivalent employees to offer workers health insurance or face penalties that can exceed $2,000 per employee. Ms. Hunter, who has 45 employees, is determined not to cross that threshold. Paying for health insurance would wipe out her company’s profit and the five-figure salary she pays herself from it, she said.

The margins are not big enough within our industry to support it,” she said. “It’s not that I don’t want to — I love my employees, and I want to do everything I can for them — but the numbers just don’t work.”

The health care law’s employer mandate, a provision that business groups fought against fiercely, is intended to make affordable health insurance available to more people by requiring employers to bear some of the cost of providing it.

Without the mandate, the law’s creators feared, companies would be tempted to cancel their insurance benefits and encourage employees to move to the online marketplace exchanges created by the law, where many low- and middle-income workers qualify for government subsidies. Those who are offered insurance through their jobs are ineligible to collect subsidies if they instead choose to buy coverage through the exchanges.

The rule took effect this year for businesses with 100 or more workers, but companies with 50 to 99 employees got an extra year to comply. Those with fewer than 50 workers are exempt.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Thousands Who Didn’t File Tax Returns May Lose Health Care Subsidies

Tens of thousands of people with modest incomes are at risk of losing health insurance subsidies in January because they did not file income tax returns, federal officials and consumer advocates say.

Under federal rules, anyone who receives an insurance subsidy must file a tax return to verify that the person was eligible and received the proper amount of financial assistance based on household income.

When the federal insurance marketplace opens for the third enrollment season next Sunday, users will see a new question: “Did your household file a 2014 tax return and reconcile any premium tax credit you used?”

If the answer to that question is no, consumers risk losing the subsidies they receive to help pay premiums. Without such assistance, many would find insurance unaffordable.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

 

Supreme Court Rules in Favor of Obama Administration

The Supreme Court ruled in favor of the Obama Administration in the controversial King vs. Burwell court case.  The 6-3 decision confirms that the Affordable Care Act allows for tax subsidies to flow through both state-based marketplaces as well as the federally organized health insurance exchange.  While the political implications are significant, this ruling should have little impact on business as usual.

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

 

Poll: Americans Largely Oblivious to Supreme Court Case on Obamacare’s Future

7 in 10 Americans have heard little or nothing about the case

A great deal of Americans will be taken by surprise should the Supreme Court rule against the Affordable Care Act in the coming weeks — a new poll finds seven in ten Americans say they’ve only heard a little or nothing at all about the pending case.

According to a new poll by the Henry J. Kaiser Family Foundation, 44% of Americans haven’t heard anything while 28% have heard only a little about King v. Burwell, a case due to be heard within weeks that could cause millions to lose federal subsidies for health insurance.

Though more people report knowing about the case than did when the Court announced it would take it up, the lack of knowledge isn’t a good sign given the impact the case could have on health insurance for low and middle-income Americans.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

IRS Fact Sheet: Determining Large Employer Status

Fact Sheet Includes Examples and Additional Resources

A fact sheet from the IRS helps employers determine, based on their size, whether the ACA’s employer shared responsibility (“pay or play”) and information reporting provisions apply to their company.

The fact sheet includes basic information on determining large employer status, along with information on:

  • Determining the number of full-time and full-time equivalent employees
  • Large employer determination examples
  • Employer aggregation rules
  • The exception for seasonal workers
  • New employers
  • 2015 transition relief for determining workforce size

More information about determining large employer status can be found here.

Visit our Pay or Play section for additional details.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

The New York State Department Extends December 15th Deadline

The New York State Department of Health today announced an extension of the December 15 deadline for enrolling or renewing individual & family health insurance coverage through the NY State of Health (NYSOH) Marketplace. The deadline to apply for or renew coverage that takes effect January 1 has been extended through December 20. This affords consumers 5 additional days to complete these transactions. With the recent adverse weather conditions in parts of New York, consumers may have experienced delays in enrolling, and this extension aims to give everyone extra time to get covered.

This is for the Individual Marketplace only – This extension DOES NOT apply to the Small Business Marketplace which will close on 12/15/14 for a January 1st effective date as planned

A link to the state’s press release is here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

The Freelancers Union No Longer Providing Health Insurance

The Freelancers Union, which provides health insurance to 25,000 of its members in New York State, is ending an experiment in providing low-cost insurance to independent workers, saying the new landscape created by the federal Affordable Care Act makes it impossible to do so.

The union’s decision came after the state gave the Freelancers Insurance Company, which the union created in 2008, a one-year exemption from the act’s provisions so that it would have time to adjust.

But officials of the union said on Tuesday that to stay in business as an insurance provider, it would have to raise premiums by 14 percent across the board, a direct conflict with its reason for going into the insurance business in the first place. In 2014, monthly premiums for the plans, which were only offered in New York, averaged $502.

If they do nothing, the freelancers who belonged to the union plans will be automatically enrolled in one of an array of Empire BlueCross BlueShield plans with benefits that the union says mirror what it has, an assertion some members dispute. Members can also choose to buy insurance on their own. The current plans will expire at the end of the year. Some freelancers, who were notified of the change by email on Tuesday, said they were distressed to find that the Empire plans were different from their old ones in some critical ways.

Unlike some of the old plans, the new plans do not allow members to go outside a fixed network of doctors. The new network will have about 20 percent fewer doctors than the old network.

“I got the email today. I looked at it and said ‘Oy,’ ” said Josh Baran, a public relations consultant in Manhattan. Mr. Baran said his current freelancers’ plan allows him to go to any specialist in the network without a referral and with a $50 co-payment. Under the Empire plan recommended for him, he said, he would have a slightly lower premium but would need to referrals. Also, he said, the network has higher co-payments and fewer doctors.

Unlike some of the old plans, the new plans do not allow members to go outside a fixed network of doctors. The new network will have about 20 percent fewer doctors than the old network.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary