Tag: ACA

  • Of course, retirement doesn’t look good when you don’t have any savings

    July 8, 2019

    Tags: ,

     

    The reports and the anecdotal stories of bankruptcy are piling up.  Some are blaming the Affordable Care Act, some the insurance carriers, some simply the high cost of medical care and of course the employers for cutting back on the level of coverage they provide (when they are not cutting back the amount they allow for premium payments).  In a new report titled “The US Healthcare Cost Crisis,” which surveyed more than 3,500 adults, it was estimated that seniors have pulled an estimated $22 billion from their long-term savings for healthcare-related expenses, an average of $3,789.  Major findings from the report are:

     

    10% of those 65 and older did not seek needed treatment in the past year due to cost

    About 7 million seniors could not afford to pay for prescriptions in the last year

    80% of the prescriptions that seniors can’t afford are used to treat serious conditions

    92% of seniors believe the cost of healthcare will not improve or will get worse

    45% are afraid they will have to file for bankruptcy if faced with a healthcare crisis

  • While Proposals are Pushed, those Previously Promoted are being Pulled

    June 17, 2019

    Tags: ,

     

    The Trump administration promoted Association Health Plans as an option to help bring down costs with employers banding together with another form of “collective bargaining” The House Ways and Means Committee has pulled this from a health care bill, which simply amplifies the negative feelings about it.  A Federal judge also struck down the plan in late March, saying that association health plans were clearly an end run around the consumer protections promised under the Affordable Care Act.  This was done right in Trump’s backyard, with a DC judge making the ruling, in response to a suit filed by 11 Attorneys General.  At the same time, President Trump said at a rally, “We are going to get rid of Obamacare…the Republican Party will become the party of great health care.”

  • Running Up the Middle – Let’s Keep the Affordable Care Act

    June 5, 2019

    Tags: ,

     

    Well remembered for urging the House to “pass the bill so we can see what’s in it,” House Speaker Nancy Pelosi has urged caution on Medicare for All, believing that the Affordable Care Act is still the best path to ‘quality, affordable care’  She clarified in an interview that Medicare for All, for most people, simply means “coverage for all” which then does not necessitate using a single payer system as advocated by Bernie Sanders.

    President Trump, meanwhile, got support to drop the ACA when a District Court judge in Northern Texas said that ACA was unconstitutional.  There is an appeal filed from a group of Attorneys General protesting this move.  The administration continues to side with the court, with the Justice Department writing it had “determined that the district court’s judgment should be affirmed” and will file a brief. This in spite of the opposition of HHS Secretary Alex Azar and Attorney General William Barr.

  • What’s the Plan? Republicans Respond to Medicare for All but Stall

    June 3, 2019

    Tags: , ,

    Republicans have a counter, though no one yet knows what it is.  President Trump has promised…to show what it is after the 2020 elections.  He has endorsed some proposals already, which may be included in his more comprehensive plan.  One (Graham-Cassidy) shows the elimination of the ACA Medicaid expansion and insurance subsidies, with the money being reallocated to the states, who would also be able to override some ACA benefit standards.  The 2020 White House budget points to this by creating block grants to the states for a similar purpose.  Conservatives also have a plan, which follows a similar path.  In short, everyone is against having the Federal government run it – they are all passing to the states.

    Of course, Trump really does need a plan, given that his 2020 budget calls for a cut of more than $845 billion in Medicare, purportedly to “cut waste, fraud and abuse.”  The OMB director said “he’s not cutting Medicare in this budget” so…so how can we have Medicare for all when Medicare itself is always under attack?

    The general grouping of proposals are:

    • Passing block grants and funding to the states
    • Adding public plan features to private insurance
    • Giving people a choice of public plans alongside private plans (e.g. Medicare for those age 50 to 64 while still being able to buy private insurance instead)

  • Cadillac, Cadillac…first it was a big deal, and now?

    April 23, 2019

    Tags:

    One of the aspects of the Affordable Care Act, which was supposed to occur in the distant future (now the recent past of 2018), was the so called “Cadillac Tax,” which would tax those who had “rich” plans for the “excess” over a basic determined level – just 40%.

    The reason for its enactment was to ensure that there was some funding that would cover some of the anticipated deficits in the ACA.  Unfortunately, no one realized how many people it would affect, as it was not adjusted for area (the Bay Area generally runs above the limits, but Arkansas and more rural states do not), income, or other area adjusted factors.  Now the tax has been delayed twice, with the latest incarnation set to appear in 2022.  Now new bills have been proposed to repeal it altogether, but without a replacement for the income loss it represents.  We may see this in our rear view mirror soon…

  • Court Blocks New DOL Rules on Association Health Plans | CA Benefits Group

    April 4, 2019

    Tags: ,

    In March, a federal district court struck down a Department of Labor (DOL) Rule on Association Health Plans (AHPs). Issued in 2018, the DOL rule aimed to expand the availability of AHPs to a greater number of small businesses as an alternative to standard ACA-compliant small group insurance policies. For details, see our June 2018 blog post.

    AHPs, also known as Multiple Employer Welfare Arrangements (MEWAs), have been around for years but, under DOL rules before 2018, they generally were limited to associations formed by employers in the same trade, industry, or profession. Traditionally, this meant employers that had employees and that also shared a “commonality of interest.” The 2018 DOL rule expanded the meaning to include employers without a shared interest if they were merely located in the same state or metropolitan area, including businesses without any employees. The key concern of states that objected to the new DOL rule was that disparate businesses, and even individuals with no employees, could form AHPs to avoid the ACA’s consumer protections. State insurance laws control the type of policies issued in each state (and various states already prohibit or restrict AHPs) but self-funded plans that are subject to ERISA may be able to avoid state law.

    The 2018 DOL rule was quickly challenged by 11 different states and the District of Columbia, led by the Attorney General of New York. On March 28, 2019, Judge John D. Bates of the U.S. District Court agreed with the states, saying the DOL rule “was intended and designed to end run the requirements of the ACA, [and] it does so only by ignoring the language and purpose of both ERISA and the ACA.”

    In State of New York, et al v. DOL, Judge Bates went on to say the “DOL unreasonably expands the definition of “employers” to include groups without any real commonality of interest and to bring working owners without employees within ERISA’s scope despite Congress’s clear intent that ERISA cover benefits arising out of employment relationships. Accordingly, these provisions are unlawful and must be set aside.”

    To recap, the 2018 DOL rule on AHPs has been vacated by the federal district court. The DOL may choose to seek a stay of the ruling, appeal the ruling, or rewrite its rule. In the meantime, the DOL pre-2018 rules continue to apply.

    Lastly, on a separate note, the name Judge John D. Bates may ring a bell with those in the employee benefits field. He is the same judge who vacated the EEOC rules on voluntary wellness programs in AARP v EEOC. The D.C. District Court, to which Judge Bates was appointed by President Bush, often hears cases involving federal laws, including ERISA and the ACA.

    by Rachel Sobel

    Originally posted on ThinkHR.com

  • Negotiations are now possible, if you can figure out the numbers

    February 28, 2019

    Tags: ,

    A new rule went into effect January 1 requiring hospitals to publish their online price lists for all the medical services they provide.  This was required under the ACA, but now they must be published online in a format that can be downloaded.  The central website for California hospitals for the most common outpatient procedures is www.oshpd.ca.gov/data-and-reports/cost-transparency/hospital-chargemasters/2018-chargemasters

     

  • ACA won’t go away…and the courts are courting further argument

    February 27, 2019

    Tags:

    California’s Attorney General Xavier Becerra is leading the charge of other Attorneys General to appeal a ruling by a conservative Texas federal judge saying that the ACA is unconstitutional.  Even that judge has already said he would reconsider, but for now the rule stands.  The appeal to the US Court of Appeals for the Fifth Circuit is joined by 16 states and the District of Columbia.  “In this particular case we believe the stakes are not only great, but compelling” Becerra, who voted for the ACA when he was a House representative, said.  Ellen Rosenblum from Oregon said “really, this is an absurd interpretation of the law and an overreach of the federal court that will hopefully be stopped at the appellate level”  Of course, others disagree “The court’s decision was about restoring the rule of law and federalism by eliminating an illegal, unconstitutional federal power grab” said a spokesman for the Texas Attorney General.

  • How gruesome is the Newsom model going to be? Or will it be at all…in California

    February 23, 2019

    Tags:

    On his first day in office, the new California governor unveiled a sweeping health plan that would prop up the ACA, expand health care for undocumented immigrants and give the state new powers to negotiation drug prices.  It would fall short of what was indicated in his campaign, however, where he hinted at a Single Payer Health Plan (adored by some, reviled by others).  His plan would reinstate the individual mandate by taxing those who do not have coverage.  While stopping short, Newsom did write to President Trump and congressional leaders asking for permission for California to pursue a government funded health care system.

  • ACA may be here to stay – the judge rules against it, but says it is in place for now

    February 21, 2019

    Tags:

    There has been lots of excitement over the Texas decision ruling the ACA is unconstitutional. Judge Reed O’Connor has now issued a stay of his own opinion, which means the law remains in effect while the inevitable (and already filed) appeals go forward.  Now that the Democrats are in charge of the White House, there will be some other action on this as well, we’re sure.

  • Proposed 2020 Benefit Payment and Parameters Rule | California Benefits Group

    January 30, 2019

    Tags: , ,

    The Centers for Medicare & Medicaid Services (CMS) released a proposed rule for benefit payment and parameters for 2020. CMS also released its draft 2020 actuarial value calculator and draft 2020 actuarial value calculator methodology.

    According to CMS, the proposed rule is intended to reduce fiscal and regulatory burdens associated with the Patient Protection and Affordable Care Act (ACA) across different program areas and to provide stakeholders with greater flexibility.

    Although the proposed rule would primarily affect the individual market and the Exchanges, the proposed rule addresses the following topics that may impact employer-sponsored group health plans:

    • Changes related to prescription drug policy
    • Small Business Health Options Program (SHOP)
    • Prohibition against discrimination
    • Maximum annual limitation on cost sharing for plan year 2020
    • Cost-sharing requirements for generic drugs
    • Cost-sharing requirements and drug manufacturers’ coupons

    CMS usually finalizes its benefit payment and parameters rule in the first quarter of the year following the proposed rule’s release. February 19, 2019 is the due date for public comments on the proposed rule.

    The 2020 open enrollment period will run from November 1, 2019, to December 15, 2019.

     

    by Karen Hsu
    Originally posted on UBABenefits.com

     

  • Is the ACA dead yet? The current administration would like to think so, and the courts help | Arrow Benefits Group

    January 8, 2019

    Tags: ,

    In response to a joint lawsuit filed by several attorneys general, the Texas District Federal Court (NFIB vs. Sebelius) has now ruled that the individual mandate as required under the Affordable Care Act may no longer be upheld under the Tax Power (following passage of the Tax Cuts and Jobs Act of 2017).  The US Supreme Court had already ruled that the individual mandate could not be severed from the Affordable Care Act, but “under the law as it now stands, the Individual Mandate no longer ‘triggers a tax’ beginning in 2019.  So long as the shared responsibility payment is zero…the Individual Mandate cannot be upheld under Congress’ Tax Power”  This means that the mandate is now unconstitutional.

  • Of course, retirement doesn’t look good when you don’t have any savings

    July 8, 2019

    Tags: ,

     

    The reports and the anecdotal stories of bankruptcy are piling up.  Some are blaming the Affordable Care Act, some the insurance carriers, some simply the high cost of medical care and of course the employers for cutting back on the level of coverage they provide (when they are not cutting back the amount they allow for premium payments).  In a new report titled “The US Healthcare Cost Crisis,” which surveyed more than 3,500 adults, it was estimated that seniors have pulled an estimated $22 billion from their long-term savings for healthcare-related expenses, an average of $3,789.  Major findings from the report are:

     

    10% of those 65 and older did not seek needed treatment in the past year due to cost

    About 7 million seniors could not afford to pay for prescriptions in the last year

    80% of the prescriptions that seniors can’t afford are used to treat serious conditions

    92% of seniors believe the cost of healthcare will not improve or will get worse

    45% are afraid they will have to file for bankruptcy if faced with a healthcare crisis

  • While Proposals are Pushed, those Previously Promoted are being Pulled

    June 17, 2019

    Tags: ,

     

    The Trump administration promoted Association Health Plans as an option to help bring down costs with employers banding together with another form of “collective bargaining” The House Ways and Means Committee has pulled this from a health care bill, which simply amplifies the negative feelings about it.  A Federal judge also struck down the plan in late March, saying that association health plans were clearly an end run around the consumer protections promised under the Affordable Care Act.  This was done right in Trump’s backyard, with a DC judge making the ruling, in response to a suit filed by 11 Attorneys General.  At the same time, President Trump said at a rally, “We are going to get rid of Obamacare…the Republican Party will become the party of great health care.”

  • Running Up the Middle – Let’s Keep the Affordable Care Act

    June 5, 2019

    Tags: ,

     

    Well remembered for urging the House to “pass the bill so we can see what’s in it,” House Speaker Nancy Pelosi has urged caution on Medicare for All, believing that the Affordable Care Act is still the best path to ‘quality, affordable care’  She clarified in an interview that Medicare for All, for most people, simply means “coverage for all” which then does not necessitate using a single payer system as advocated by Bernie Sanders.

    President Trump, meanwhile, got support to drop the ACA when a District Court judge in Northern Texas said that ACA was unconstitutional.  There is an appeal filed from a group of Attorneys General protesting this move.  The administration continues to side with the court, with the Justice Department writing it had “determined that the district court’s judgment should be affirmed” and will file a brief. This in spite of the opposition of HHS Secretary Alex Azar and Attorney General William Barr.

  • What’s the Plan? Republicans Respond to Medicare for All but Stall

    June 3, 2019

    Tags: , ,

    Republicans have a counter, though no one yet knows what it is.  President Trump has promised…to show what it is after the 2020 elections.  He has endorsed some proposals already, which may be included in his more comprehensive plan.  One (Graham-Cassidy) shows the elimination of the ACA Medicaid expansion and insurance subsidies, with the money being reallocated to the states, who would also be able to override some ACA benefit standards.  The 2020 White House budget points to this by creating block grants to the states for a similar purpose.  Conservatives also have a plan, which follows a similar path.  In short, everyone is against having the Federal government run it – they are all passing to the states.

    Of course, Trump really does need a plan, given that his 2020 budget calls for a cut of more than $845 billion in Medicare, purportedly to “cut waste, fraud and abuse.”  The OMB director said “he’s not cutting Medicare in this budget” so…so how can we have Medicare for all when Medicare itself is always under attack?

    The general grouping of proposals are:

    • Passing block grants and funding to the states
    • Adding public plan features to private insurance
    • Giving people a choice of public plans alongside private plans (e.g. Medicare for those age 50 to 64 while still being able to buy private insurance instead)

  • Cadillac, Cadillac…first it was a big deal, and now?

    April 23, 2019

    Tags:

    One of the aspects of the Affordable Care Act, which was supposed to occur in the distant future (now the recent past of 2018), was the so called “Cadillac Tax,” which would tax those who had “rich” plans for the “excess” over a basic determined level – just 40%.

    The reason for its enactment was to ensure that there was some funding that would cover some of the anticipated deficits in the ACA.  Unfortunately, no one realized how many people it would affect, as it was not adjusted for area (the Bay Area generally runs above the limits, but Arkansas and more rural states do not), income, or other area adjusted factors.  Now the tax has been delayed twice, with the latest incarnation set to appear in 2022.  Now new bills have been proposed to repeal it altogether, but without a replacement for the income loss it represents.  We may see this in our rear view mirror soon…

  • Court Blocks New DOL Rules on Association Health Plans | CA Benefits Group

    April 4, 2019

    Tags: ,

    In March, a federal district court struck down a Department of Labor (DOL) Rule on Association Health Plans (AHPs). Issued in 2018, the DOL rule aimed to expand the availability of AHPs to a greater number of small businesses as an alternative to standard ACA-compliant small group insurance policies. For details, see our June 2018 blog post.

    AHPs, also known as Multiple Employer Welfare Arrangements (MEWAs), have been around for years but, under DOL rules before 2018, they generally were limited to associations formed by employers in the same trade, industry, or profession. Traditionally, this meant employers that had employees and that also shared a “commonality of interest.” The 2018 DOL rule expanded the meaning to include employers without a shared interest if they were merely located in the same state or metropolitan area, including businesses without any employees. The key concern of states that objected to the new DOL rule was that disparate businesses, and even individuals with no employees, could form AHPs to avoid the ACA’s consumer protections. State insurance laws control the type of policies issued in each state (and various states already prohibit or restrict AHPs) but self-funded plans that are subject to ERISA may be able to avoid state law.

    The 2018 DOL rule was quickly challenged by 11 different states and the District of Columbia, led by the Attorney General of New York. On March 28, 2019, Judge John D. Bates of the U.S. District Court agreed with the states, saying the DOL rule “was intended and designed to end run the requirements of the ACA, [and] it does so only by ignoring the language and purpose of both ERISA and the ACA.”

    In State of New York, et al v. DOL, Judge Bates went on to say the “DOL unreasonably expands the definition of “employers” to include groups without any real commonality of interest and to bring working owners without employees within ERISA’s scope despite Congress’s clear intent that ERISA cover benefits arising out of employment relationships. Accordingly, these provisions are unlawful and must be set aside.”

    To recap, the 2018 DOL rule on AHPs has been vacated by the federal district court. The DOL may choose to seek a stay of the ruling, appeal the ruling, or rewrite its rule. In the meantime, the DOL pre-2018 rules continue to apply.

    Lastly, on a separate note, the name Judge John D. Bates may ring a bell with those in the employee benefits field. He is the same judge who vacated the EEOC rules on voluntary wellness programs in AARP v EEOC. The D.C. District Court, to which Judge Bates was appointed by President Bush, often hears cases involving federal laws, including ERISA and the ACA.

    by Rachel Sobel

    Originally posted on ThinkHR.com

  • Negotiations are now possible, if you can figure out the numbers

    February 28, 2019

    Tags: ,

    A new rule went into effect January 1 requiring hospitals to publish their online price lists for all the medical services they provide.  This was required under the ACA, but now they must be published online in a format that can be downloaded.  The central website for California hospitals for the most common outpatient procedures is www.oshpd.ca.gov/data-and-reports/cost-transparency/hospital-chargemasters/2018-chargemasters

     

  • ACA won’t go away…and the courts are courting further argument

    February 27, 2019

    Tags:

    California’s Attorney General Xavier Becerra is leading the charge of other Attorneys General to appeal a ruling by a conservative Texas federal judge saying that the ACA is unconstitutional.  Even that judge has already said he would reconsider, but for now the rule stands.  The appeal to the US Court of Appeals for the Fifth Circuit is joined by 16 states and the District of Columbia.  “In this particular case we believe the stakes are not only great, but compelling” Becerra, who voted for the ACA when he was a House representative, said.  Ellen Rosenblum from Oregon said “really, this is an absurd interpretation of the law and an overreach of the federal court that will hopefully be stopped at the appellate level”  Of course, others disagree “The court’s decision was about restoring the rule of law and federalism by eliminating an illegal, unconstitutional federal power grab” said a spokesman for the Texas Attorney General.

  • How gruesome is the Newsom model going to be? Or will it be at all…in California

    February 23, 2019

    Tags:

    On his first day in office, the new California governor unveiled a sweeping health plan that would prop up the ACA, expand health care for undocumented immigrants and give the state new powers to negotiation drug prices.  It would fall short of what was indicated in his campaign, however, where he hinted at a Single Payer Health Plan (adored by some, reviled by others).  His plan would reinstate the individual mandate by taxing those who do not have coverage.  While stopping short, Newsom did write to President Trump and congressional leaders asking for permission for California to pursue a government funded health care system.

  • ACA may be here to stay – the judge rules against it, but says it is in place for now

    February 21, 2019

    Tags:

    There has been lots of excitement over the Texas decision ruling the ACA is unconstitutional. Judge Reed O’Connor has now issued a stay of his own opinion, which means the law remains in effect while the inevitable (and already filed) appeals go forward.  Now that the Democrats are in charge of the White House, there will be some other action on this as well, we’re sure.

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