A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Report finds state differences in EHBs

Posted on October 23, 2014 | No Public Comments

A new report from University of Pennsylvania researchers, funded by the Robert Wood Johnson Foundation, finds that significant state variation exists in the Affordable Care Act (ACA) essential health benefits (EHB), which insurers must cover to offer plans on the exchanges. 45 states consider chiropractic care an EHB, 26 states include autism spectrum disorder services in their EHB package, and only five states considered weight loss programs and acupuncture as EHBs. The report states that the variation in EHB requirements is mostly a result of allowing states to determine their own essential health benefit package by using a “benchmark plan” already offered in the state as a model.

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CMS issues Basic Health Program information for 2016

Posted on October 22, 2014 | No Public Comments

The Centers for Medicare and Medicaid Services (CMS) issued a proposed notice on how the federal government will determine payment amounts for 2016 for states that decide to establish a Basic Health Program. The Basic Health Program is a voluntary option under the Affordable Care Act (ACA), which provides insurance to individuals between 133 and 200 percent of poverty through a separate program rather than having them go to the exchanges. The proposed notice says that states that establish the program will receive federal funding equal to 95 percent of the amount of premium tax credits and cost-sharing subsidies that would have otherwise been provided to those individuals for exchange plans. However, the funding does not cover states’ ongoing administrative or operational costs.

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ACA health plan agreements include Halbig provision

Posted on October 21, 2014 | No Public Comments

Insurers must sign Affordable Care Act (ACA) qualified health plan (QHP) agreements in order to offer their plans on HealthCare.gov for 2015. The 2015 agreements include a provision that takes into account the fact that the Supreme Court could issue a ruling on the Halbig v. Burwell case sometime next year that would make ACA subsidies illegal in federal exchange states. In the agreements, CMS reassures plans that if ACA premium tax credits and cost-sharing subsidies are no longer available to qualifying enrollees in the federal exchanges, the health plan could have cause to terminate the agreement subject to applicable state and federal law.

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Survey assesses impact of high deductibles

Posted on October 14, 2014 | No Public Comments

A new poll conducted by the The Associated Press and the NORC Center for Public Affairs Research suggests that high deductibles remain a significant barrier to health care for many privately insured Americans. The survey finds that of privately insured adults under age 64, about one in five said they don’t go to a doctor when they are sick despite having health coverage. A similar number of survey respondents reported going without preventive care and cutting back on retirement savings, or having to use all their savings for care. These issues were particularly acute among the 26 percent of respondents with high deductible plans. Consequently, about half of those surveyed said they preferred higher premiums over higher out-of-pocket costs.

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CMS issues guidance on ACA health insurance tax

Posted on October 9, 2014 | No Public Comments

Guidance issued by the Centers for Medicare and Medicaid Services (CMS) advises states that that their capitated payment rates for Medicaid managed care plans should cover the costs of the Affordable Care Act’s (ACA) health insurance tax, as it is considered a “reasonable business cost.” The tax starts at $8 billion in 2014 and increases every year, up to $14.3 billion in 2018. Starting in 2019, the amount of the tax will increase annually based on premium trends. CMS contends that this fee is not unlike other taxes and fees that actuaries must take into account when developing capitation rates.

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Oklahoma judge rules on ACA tax subsidies

Posted on September 30, 2014 | No Public Comments

A federal judge in Oklahoma ruled that tax subsidies granted under the Affordable Care Act (ACA) cannot go to residents of states with a federally-facilitated health insurance exchange rather than a state-run exchange. The ruling is similar to the D.C. Circuit’s decision in Halbig v. Burwell earlier this month. The government has requested an en banc review of the US Court of Appeals for the DC Circuit in order to ensure an opportunity to resolve circuit split before the Supreme Court grants cert.

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DOL issues final rule on excepted benefits

Posted on September 30, 2014 | No Public Comments

The Department of Labor (DOL) issued a final rule regarding excepted benefits and stand-alone dental and vision plans. In the original proposed rule if the wraparound coverage met a number of requirements, it would have been considered an excepted benefit that would not disqualify the employee from getting subsidized coverage on the exchanges. However, this language is excluded from the final rule issued. The DOL said it intends to publish regulations on the topic of wraparound coverage in the future, taking into account the extensive comments received on the topic.

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Georgetown releases report on post-ACA network design

Posted on September 23, 2014 | No Public Comments

Researchers at Georgetown University’s Center on Health Insurance Reforms (CHIR) conducted a six-state case study to assess changes in the network design of plans offered through the health insurance marketplaces, as well as the response of state officials in the face of consumer and provider concerns. The report finds that insurers have narrowed their networks, relative to what they offered in the past, however states and insurers reported few consumer complaints about the ability to obtain medically necessary care in-network. Most of the study states are unlikely to take action to change their standards for network adequacy, however, half of the states studied will require insurers to provide better, up-to-date provider directories, so that consumers can better understand which providers are in which plan networks before they buy.

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OIG releases report on security of online Marketplaces

Posted on September 23, 2014 | No Public Comments

The Office of the Inspector General (OIG) conducted an audit of Healthcare.gov, the online Federal Marketplace, from February to June 2014, including vulnerability scans and simulated attacks. In doing so, they found that the site’s security had been improved since last October’s launch of the insurance marketplace. However, OIG still found some vulnerabilities and the report recommended ways to further improve the site’s security, which the Centers for Medicare and Medicaid Services (CMS) says have already been implemented.

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IRS issues final rule on ACA write-off limit

Posted on September 19, 2014 | No Public Comments

The Internal Revenue Service (IRS) finalized a half-million-dollar cap on deductions that the biggest insurance companies can take for executive pay. This final rule will affect certain health insurance providers giving remuneration that exceeds the deduction limitation. According to a recent analysis, the little-known Affordable Care Act (ACA) provision amounted to about $1.3 million per executive for the largest insurers in 2013. The rule details what companies and employees are subject to the limit and how it should be applied.

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