Budget, ACA Subsidies Take Center Stage as Congress Returns from Recess
When Congress returns from recess on Monday, it will have just one week to finalize a budget deal keeping the government open for the remainder of the 2017 fiscal year. President Trump’s budget request for this year calls for cuts of more than $50 billion dollars to pay for an increase in military spending. While these negotiations continue, health insurers are working with the Administration to secure more than $7 billion in cost-sharing subsidies through the Affordable Care Act. It remains to be seen how these decisions will impact major health care reform legislation.
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House GOP Releases Plan to Repeal and Replace the ACA
On Wednesday, Speaker of the House Paul Ryan (R-WI) and other House GOP leaders unveiled their alternative to President Obama’s signature health care law, the Affordable Care Act (ACA). While the plan does not include a number of specific details including the overall cost and total number of covered individuals, it does present a broad outline of a potential GOP health reform agenda for the next administration. As in the past, this initiative includes a number of proposals that would directly repeal ACA provisions as well as revamp current practices in Medicare, Medicaid and marketplace health care coverage.
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HHS Finalizes Wide-Ranging ACA Nondiscrimination Rule
On Wednesday, the Department of Health and Human Services’ Office of Civil Rights (HHS OCR) issued its final rule on nondiscrimination in federal health care programs and activities. The final rule prohibits discrimination based on race, color, national origin, age, disability and sex in all health programs and activities, any part of which receives federal financial assistance administered by HHS. The rule takes effect on July 18, 2016.
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CMS Issues Guidance on Little-known State-ACA Waivers
Beginning in 2017, states will have an avenue by which to fundamentally alter their methods for offering and regulating public health insurance. Section 1332 “State Innovation Waivers” were included in the Patient Protection and Affordable Care Act (ACA) to allow states the opportunity to pursue innovative methods of providing access to affordable, high quality health care while still maintaining the key elements of the ACA. However, there is growing concern over the potential scope of these waivers and their ability to significantly modify how states offer affordable insurance coverage through the marketplace.
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Senate Approves ACA Reconciliation Bill, Repealing Medicaid Expansion
Last week, the Senate approved a highly partisan budget reconciliation bill that repealed a significant portion of the Affordable Care Act, including Medicaid expansion. The bill also repealed the authority of the federal government to run health care exchanges and eliminated subsidies to help people afford plans purchased through those exchanges. Passed on party lines, the bill now must pass the House before heading to the President’s desk. The White House has made clear the President intends to veto the legislation, protecting his signature legislative achievement.
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CMS Finds Qualified Health Plans, CHIP too Different to Certify as Comparable
A new analysis from the Centers for Medicare and Medicaid Services finds that coverage through the Children’s Health Insurance Program (CHIP) is more comprehensive and more favorable for kids and families than marketplace exchange plans. The comparison, mandated by the Affordable Care Act, concluded that CHIP plans are more likely to meet the needs of kids and families and therefore could not certify the plans as comparable.
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CMS Finalizes Essential Health Benefits Benchmark for 2017
This week, the Centers for Medicare and Medicaid Services (CMS) finalized Essential Health Benefits benchmark plans for 2017. The essential health benefits are the minimum coverage floor for health plans sold on the state and federal marketplaces, as well as Medicaid expansion plans. While each state determines its own essential benefits, all plans must include 10 categories of coverage – including mental health and substance use.
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Supreme Court Upholds Affordable Care Act in Latest Legal Challenge
For the second time in three years, the U.S. Supreme Court today struck down a major legal challenge to the Affordable Care Act, ruling that consumers who purchase health insurance on healthcare.gov are eligible for subsidies to offset their costs.
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Supreme Court Hears Case on Affordable Care Act Subsidies
Today, the Supreme Court of the United States heard oral arguments in the King v. Burwell case, the second major challenge to the Affordable Care Act (ACA) since its enactment in 2010. For the second time, the fate of the law hangs in the balance. In this case, the court is being asked to rule on whether the law allows the federal government to offer premium subsidies to consumers who purchase health insurance in the federal marketplace, Healthcare.gov. If the federal subsidies are found to be against the terms of the law, consumers in 37 states would lose financial assistance for their insurance plans, potentially making plans unaffordable to millions.
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CCIIO Clarifies Non-Discrimination Requirements in Letter to Health Plan Issuers
In its annual draft guidance outlining the criteria and requirements by which health insurance plans can be certified to provide coverage through Healthcare.gov, the Center for Consumer Information and Insurance Oversight (CCIIO) has provided clarification on its standards for non-discrimination in plan design, network adequacy, and contracting with “essential community providers.”
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Open Enrollment Continues, Enroll America Releases “Get Covered Tools”
This week, the Department of Health and Human Services (HHS) released updated enrollment data for the second annual open enrollment period, which began on November 15. In the first two weeks, more than 765,000 people enrolled in a health insurance plan with 48 percent of these enrollments being “new consumers”. An additional 1.5 million people have submitted applications for insurance to determine their eligibility for coverage.
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Exchange Plans Raise Costs of Specialty Drugs for 2015
A new study from the health care consulting firm Avalere finds that qualified health plans sold on the federal and state marketplaces continue to use formulary tiering as a method for holding down premium costs, forcing consumers to pay more for certain specialty medications.
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CMS Updates Essential Benefits for 2016; Improves Prescription Drug Coverage
Consumers could have greater access to prescription medications in health plans sold in the state and federal Marketplaces under a new proposed rule issued by the Centers for Medicare and Medicaid Services (CMS) last week.
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“I am Essential” Coalition Urges Improvements to Essential Health Benefits
A broad coalition of national groups, including the National Council, has submitted comments to the Center for Consumer Information and Insurance Oversight (CCIIO) outlining how Essential Health Benefits should be improved to protect patient health.
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National Council Signs on to Letter Encouraging Network Adequacy Standards
The National Council signed on to a letter to the National Association of Insurance Commissioners (NAIC) encouraging them to adopt network adequacy standards that will protect consumers’ access to care, particularly specialty care like mental health and substance use treatment. The recommendations put forth in the letter establish reasonable and meaningful standards, while still allowing for health insurance market flexibility and choice.
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Open Enrollment to Begin Nov. 15; HHS Lowers Enrollment Estimate
The Affordable Care Act’s second annual open enrollment period is set to start November 15, giving Americans the opportunity to select health insurance through their state or federal marketplace. Currently, 7.1 million people are insured through a marketplace plan. The Department of Health and Human Services has said its goal is to get 9.1 million people signed up for coverage during this year’s open enrollment, a number substantially lower than the Congressional Budget Office’s projection of 13 million. If fewer people sign up for coverage, organizations that treat the uninsured could feel the crunch.
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Supreme Court to Hear Case on Health Insurance Subsidies in Federal Marketplace
On Friday, the Supreme Court agreed to hear a case challenging the legality of federal financial assistance for consumers who purchase health insurance in states that opted not to set up their own health insurance exchanges. The appeal targets a technical inconsistency in the law that states that this financial assistance is available only to consumers in states that set up and run their own exchanges. If the federal subsidies are found to be against the terms of the law, consumers in 36 states would lose federal assistance for their insurance plans, potentially making plans unaffordable to millions.
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CMS Outlines New Measures to Streamline 2015 Coverage Renewal Process
In a press release issued this week, the Centers for Medicare & Medicaid Services (CMS) highlighted new measures the agency has undertaken to expedite and improve the re-enrollment of existing Healthcare.gov marketplace enrollees for coverage effective next year.
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Judge Rules Against Health Insurance Subsidies in Federal Marketplace
Last Tuesday, a federal judge in Oklahoma ruled that Affordable Care Act (ACA) subsidies can’t go to consumers who obtained health coverage through the federal insurance marketplace. The ruling is the latest in a series of challenges to the legality of health insurance tax credits in states that opted not to run their own health insurance marketplaces. Two other federal courts have previously issued conflicting rulings on this issue.
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Most Uninsured May Be Exempt from ACA Mandate Penalty
According to a new report from the Congressional Budget Office and the Joint Committee on Taxation, nearly 90 percent of the 30 million U.S. residents who are uninsured will not have to pay a penalty under the Affordable Care Act’s insurance coverage mandate in 2016 because of a growing list of exemptions. Under the health law, most U.S. residents are required to purchase individual coverage beginning this year or risk penalties of between $95 and 1 percent of their taxable income, whichever is higher. The penalties are scheduled to increase to $325 or 2 percent in 2015 and $695 or 2.5 percent in 2016.
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