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Health Affairs blog analyzes King v. Burwell oral arguments

Posted on March 9, 2015 | No Public Comments

A new Health Affairs blog examines the oral arguments in King v. Burwell, focusing on the plantiffs’ reading of the Affordable Care Act (ACA) regarding states establishing their own exchanges for the benefit of federal subsidies. Under this interpretation,the law was intended to encourage states to create their own exchange, or else receive no federal subsidy funds, which may be viewed as coercive by the Court. The blog draws parallels between the Medicaid coercion argument in NFIB v. Sebelius, where the Supreme Court ruled that requiring states to expand Medicaid under the ACA at the price of withdrawing federal funding would be unconstitutionally coercive, and the similar argument of coercion brought up in the King case. The author contends that potentially the Court will realize the deeper constitutional implications of upholding the plantiffs’ reading of the law and allow federal subsidies to continue flowing through federally facilitated exchanges.

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Paper examines potential King v. Burwell fallout

Posted on March 4, 2015 | No Public Comments

A perspective piece published in the New England Journal of Medicine predicts potential fallout from a ruling in favor of King in the King v. Burwell case currently being decided by the Supreme Court. If the challengers prevail, the U.S. Treasury will likely have to stop issuing tax credits to users of federal exchanges. Enrollees who are unable or unwilling to pay the full cost of their insurance premiums could see their coverage terminated. The authors suggest that states could choose to set up their own exchanges and delegate some responsibilities to private contractors, in order to avoid some of the technological challenges. However, the authors also note that some states may be unwilling to set up their own exchanges, in the same way they chose not to expand Medicaid.  This could lead to substantial coverage gaps for many Americans.

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Supreme Court transcript of King v. Burwell arguments posted

Posted on March 4, 2015 | Public Comment (1)

The Supreme Court of the U.S. heard oral arguments today in the King v. Burwell case, which challenges the availability of tax subsidies for individuals who purchase their health insurance on a marketplace created by the federal government. The case centers around language in the Affordable Care Act (ACA) which states that an individual is eligible for a premium subsidy, via a tax credit, if he or she is “enrolled through an exchange established by the State.” Based on this statutory language, those in state based exchanges are not at risk of losing their subsidies. The Supreme Court’s decision will apply only to the 34 states that have federally facilitated exchanges. The oral arguments featured two high-profile lawyers, Michael A. Carvin of the Washington, D.C., law firm of Jones Day, for the challengers, and U.S. Solicitor General Donald B. Verrilli, Jr., defending the Administration.

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IRS releases new ACA rules

Posted on February 24, 2015 | No Public Comments

The Internal Revenue Service (IRS) issued final temporary regulations for how it will assess the health insurance tax in 2015, including how it defines a covered entity, which is subject to the fees. The IRS also released guidance on the excise tax on high cost employer-sponsored health coverage, or “Cadillac tax”, which is scheduled to go into effect in 2018. This notice is intended to initiate and inform the process of developing regulatory guidance on the tax.

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CMS issues final rule on benefit and payment parameters for 2016

Posted on February 23, 2015 | No Public Comments

The Centers for Medicare and Medicaid Services (CMS) issued a final rule on the U.S. Department of Health and Human Services (HHS) Notice of Benefit and Payment Parameters for 2016. The final rule builds on previously issued standards to further strengthens transparency, accountability, and the availability of information for consumers about their health plans. The rule finalizes the annual open enrollment period for 2016 to begin on November 1, 2015 and run through January 31, 2016. CMS also released its final annual letter to issuers, which provides additional guidance on these and related standards for plans participating in the Federally-facilitated Marketplace.

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IRS delays penalties on small employer HRAs

Posted on February 19, 2015 | No Public Comments

The Internal Revenue Service (IRS) announced in guidance that small businesses (less than 50 employees) now have until July to end arrangements in which they give their workers tax-free payments to buy coverage on the individual market, or else face significant tax penalties. In the past, some employers have chosen to contribute to HRAs instead of providing insurance. With a health reimbursement arrangement (HRA), employees pay out-of-pocket for health services and submit claims to be paid by the employer. Some workers used these contributions to subsidize their health insurance premiums.

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GAO issues Medicaid report

Posted on February 17, 2015 | No Public Comments

The Government Accountability Office (GAO) issued a report examining (1) the extent to which Medicaid enrollees have private insurance, and (2) state and CMS initiatives to improve third-party liability (TPL) efforts. GAO found that 7.6 million Medicaid enrollees (13.4 percent) had private health insurance in 2012. Additionally, the number of Medicaid enrollees with private health insurance is expected to increase with the expansion of Medicaid. To combat this issue, GAO recommends that the Centers for Medicare and Medicaid Services (CMS) routinely monitor and share across all states information regarding key TPL efforts and challenges, as well as provide guidance on state oversight of TPL efforts conducted by Medicaid managed care plans.

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IRS issues notice on tax penalties related to premium tax credits

Posted on January 27, 2015 | No Public Comments

The Internal Revenue Service (IRS) issued a notice that provides some relief from tax penalties for taxpayers who find out when they file their taxes that they received an overpayment of premium tax credits for buying health insurance under the Affordable Care Act (ACA). The notice offers limited relief for taxpayers who have a balance due on their 2014 income tax return as a result of reconciling advance payments of the premium tax credit against the premium tax credit allowed on the tax return. To qualify for the relief, however, taxpayers must meet certain requirements and the relief applies only for the 2014 taxable year.

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New CBO report estimates ACA costs

Posted on January 26, 2015 | No Public Comments

A new report released by the Congressional Budget Office (CBO) estimates that the coverage provisions of the Affordable Care Act (ACA) will result in $76 billion in net costs to the federal government in 2015 and $1,350 billion between 2016 and 2025. These costs come almost entirely from tax subsidies, accounting for $32 billion in 2015, and from the increase in spending from Medicaid expansions, $47 billion in 2015. CBO predicts that these costs will be offset slightly by an estimated $2 billion in penalties paid by the uninsured in 2015. This new CBO estimate of the ACA’s coverage provisions represents a 7 percent decline since their last estimate.

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CMS issues FAQ on Medicaid plan marketing rules

Posted on January 20, 2015 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) posted a document which clarifies whether Medicaid managed care plans can market their private qualified health plans (QHP) to potential enrollees. CMS says federal rules do not prohibit Medicaid plans from providing information about QHPs to potential enrollees who might enroll in such a plan as an alternative to the Medicaid plan. However, CMS recommends that plans consult contracts and their state Medicaid agencies for more information on what is allowed.

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