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Latest News on the ACA

Bipartisan Senators Move to Eliminate Surprise Out-of-Network Costs
September 24, 2018

Last week, a group of six bipartisan senators created draft legislation to protect patients with insurance from extra charges from doctors and hospitals that are not in the insurance company’s network.

Often called “surprise bills,” the charges stem from non-network emergency room doctors who work in network facilities. Patients receive bills from the non-network provider that are over their deductible or co-pay limits.

The proposed bill tackles three areas:

  • Patients would pay only the out-of-pocket amount required on their plan for out-of-network emergency room doctors who work in out-of-network hospitals. Any additional “balance billing” payments would come from the insurance company.

  • Patients would pay only what is required for out-of-network doctors who work at in-network emergency rooms.

  • Emergency room patients in non-network facilities would be notified in writing that any follow-up treatments could include non-network charges unless they go to an in-network hospital.

“No American should have to file bankruptcy or fall into poverty as a result of a serious ailment or unexpected medical emergency,” said Tom Carper (D-DE), one of the sponsors of the bill. “The Affordable Care Act made great progress in reducing rates of medical bankruptcies, and this bipartisan discussion draft will build on that progress by protecting patients from surprise medical bills after they are treated in emergency situations or receive care from an out-of-network provider.”

ACA Navigators Asked to Do More With Less Funding
September 13, 2018

The Center for Medicare and Medicaid Services (CMS) announced Wednesday the 39 navigator programs that will share $10 million in funding to promote and enroll consumers into healthcare plans.

CMS Administrator Seema Verma said the 2019 program kicks off a “new direction.” Instead of exclusively enrolling uninsured residents in ACA plans, grantees are encouraged to enroll them in association health plans, short-term plans, Medicaid, and CHIP.

“This new direction will increase accountability and ensure the grants are effective in helping consumers find health coverage that meets their needs,” she said. Verma also encourages navigators to rely more heavily on volunteers and partnerships with other organizations.

These are drastic cuts compared to last year’s grants of $36 million to 90 organizations. Overall, navigators have been cut 84 percent since 2016.

2018 Tax Returns Won’t Require Proof to Claim ACA Hardship Exemption
September 10, 2018

Individuals who have opted out of healthcare coverage in 2018 will not have to provide documentation or a written explanation on their 2018 tax return to claim a hardship exemption.

Late last year, Congress repealed the individual mandate that required uninsured Americans to pay a fine. However, the change does not go into effect until 2019. For this year, the penalty is $695 or 2.5 percent of overall income, whichever is higher.

Taxpayers can avoid the penalty via the hardship exemption under some circumstances, including bankruptcy, homelessness, or a natural disaster. CMS’ new guidance requests that people who are eligible for the exemption retain all paperwork as proof in the event of an audit, but it does not need to be included with their tax form.

Poll Shows Most Americans Favor Pre-Existing Conditions Protections
September 5, 2018

A new Kaiser Family Foundation poll found that 72 percent of respondents believe that it’s “very important” that insurance companies do not charge higher premiums to people with pre-existing conditions, and 75 percent do not want people denied coverage due to their medical history. Other findings in the poll:

  • 41% are “very worried” that they or a relative could lose coverage if pre-existing conditions protections are overturned.

  • 52% of respondents are “very worried” that they or a relative would have to pay more because of a pre-existing condition.

  • 60% of respondents say they or a family member have a pre-existing condition.

  • 67% are either “somewhat worried” or “very worried” about unexpected medical bills.

  • 50% of overall respondents have a favorable view of the Affordable Care Act. (77% of Democrats are favorable; 22% of Republicans are favorable.)

Analysis: Overall 2019 ACA Premiums Could Increase up to 4%
September 4, 2018

Premiums for 2019 healthcare plans sold on the Affordable Care Act marketplace are expected to increase by less than 4 percent nationwide, according to an analysis by Charles Gaba of ACASignups.net.

While a few states such as Kentucky and Connecticut will experience increases of 12 percent, other states such as Tennessee and New Hampshire will see declines, according to the findings.

Gaba also found that the Trump administration’s actions prevented additional drops in premium costs. Eliminating the individual mandate penalty, dropping cost-sharing reduction (CSR) payments, and offering “skimpy” short-term insurance have contributed to weakening the marketplace.

Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, agrees that rates will rise modestly. She also points out that insurance companies selling ACA policies are expanding into new markets.

“The news about the marketplace this year is very good, both in terms of the premium increase and extent of carrier participation,” Hempstead said.

Senate Democrats Move to Overturn New Short-Term Health Insurance Rule
August 30, 2018

Senator Tammy Baldwin (D-WI) introduced legislation to force a vote to block a Trump administration rule that expands short-term health insurance plans from three months to one year.

The plans fall short of Affordable Care Act protections for people with pre-existing conditions and don’t require essential benefits such as prescription drugs, maternity care, and mental health coverage.

In a statement, Baldwin called the plans “junk insurance” and said that they “could increase costs and reduce access to quality coverage for millions, force premium increases on older Americans, and harm people with pre-existing conditions.”

The bill would require the support of two Republicans to pass in the Senate. Passage in the House is unlikely, as the Republican majority has shown strong support for the extension, saying that the plans are a cost-effective alternative for consumers who aren’t able to afford comprehensive health coverage.

ACA Has Helped Reduce Number of Uninsured by 58%
August 29, 2018

The number of uninsured dropped from 29.3 million in 2017 to 28.3 million the first quarter of 2018, according to new data from the Centers for Disease Control and Prevention show.

That compares to 48.6 million uninsured in 2010, prior to the enactment of the Affordable Care Act—a 58.2 percent reduction.

Other findings in the data show:

  • There are 12.5 percent Americans between the ages of 18 and 64 who remain uninsured.
  • In Arkansas, Louisiana, Oklahoma, and Texas, almost 25 percent of adults are uninsured.
  • Twenty percent of insured adults are covered by public plans, while 70 percent are covered by private plans.
  • More than 95 percent of children are insured by either public or private plans.
  • The number of people under age 65 covered by ACA plans in 2018 is 9.7 million, about 1 million fewer people than last year.

GOP-Backed Bill Offers ACA Pre-Existing Condition Protections; Critics Call It a ‘Mirage’
August 27, 2018

In response to a lawsuit challenging the legality of the Affordable Care Act, Senator Thom Tillis (R-NC) and 10 Senate Republican co-signers have introduced a bill to preserve the law’s protections for people with pre-existing conditions.

The lawsuit was filed by 20 Republican state attorneys general and will be heard by a federal judge next month.

The proposed bill would require insurance companies to cover all individuals regardless of health status and ensure that premiums are not revised based on health.

But some critics believe the bill creates a loophole that enables insurance companies to revive the kinds of activities that prompted ACA talks in the first place. The bill holds insurers to guaranteeing access to coverage on the individual market; however, insurance companies could still use exclusions to limit coverage for pre-existing conditions and related ailments.

“If the goal is to protect people with pre-existing conditions, the bill is a bit of a mirage,” said Larry Levitt, senior vice president for health reform at the bipartisan Kaiser Family Foundation.

Report Critiques Trump Administration’s First ACA Signup Year
August 23, 2018

The nonpartisan Government Accountability Office has released a report that examines how the Trump administration managed the 2018 Affordable Care Act Open Enrollment Period and makes recommendations for improvements.

The report credits Health and Human Services (HHS) for improving the reliability of the federal enrollment site and reducing call center wait times.

However, the following areas are lacking and need addressing, according to the watchdog group:

  • HHS did not set enrollment targets as it had during the Obama administration.
  • HHS used “unreliable” data to justify a 40 percent cut to the Navigator programs.
  • Television advertising was proven to be the most effective method to help enroll consumers. However, the Trump administration slashed the entire budget.

The report also found that states using the government site for enrollments had a 5 percent reduction, while states that run their own exchanges maintained enrollment levels. It also confirmed that the Trump administration’s discontinuation of cost-sharing reduction (CSR) payments contributed to “substantial increases” in premiums.

Trump Administration Will Distribute $8.6 Million to States for Healthcare Initiatives
August 21, 2018

The Centers for Medicare and Medicaid Services (CMS) will award $8.6 million in unspent Affordable Care Act funding to 30 states and the District of Columbia to help stabilize their insurance exchanges.

The two-year grants range from $225,000 to $290,000 and can be used to expand consumers’ healthcare options. All states that applied for the funds received them.

The grant funds come from money set aside as part of the Affordable Care Act for states to review health insurance proposals.

In a statement, CMS Administrator Seema Verma said, “These grants build on CMS’s ongoing efforts to give states the tools and flexibility they need to help people struggling to afford the year-over-year premium increases caused by Obamacare regulations. We recognize that states are in the best position to assess the needs of their consumers and develop innovative measures to ensure access to affordable health coverage. These grants make yet another down payment on our work to enhance states’ ability to stabilize and improve their respective health insurance markets.”

Senate Democrats Try to Block Short-Term Health Plans
August 3, 2018

In response to the Trump administration’s new final rule on short-term healthcare plans, Senate Democrats are planning to introduce a resolution to upend it. However, the measure to overturn the rule is unlikely to pass since the legislation would need to be signed by President Donald Trump.

The lawmakers say that, since the plans are not required to cover people with pre-existing conditions or adhere to the Affordable Care Act’s essential benefits, the plans are “nothing short of junk insurance.”

“We cannot let the Trump administration rewrite the rules on the guaranteed healthcare protections that people depend on because no family should be forced to choose between helping a loved one get better or going bankrupt,” said Tammy Baldwin (D-WI), one of the senators leading the measure.

Senate Minority Leader Charles Schumer (D-NY) will force a vote under the Congressional Review Act, which means Republicans will be unable to block it.

“This is an issue the American people should know where everyone stands,” Schumer said. “Let them, instead of saying they’re for it, actually do something to preserve pre-existing conditions.”

Four Cities Sue Trump for Undermining the ACA
August 2, 2018

The cities of Chicago, Columbus, Cincinnati, and Baltimore filed a lawsuit today in Maryland federal court against President Donald Trump, claiming he has not faithfully executed the Affordable Care Act, which is in violation of the Constitution.

The complaint charges that Trump “waged a relentless effort to use executive action alone to undermine and, ultimately, eliminate the law,” according to a draft of the lawsuit obtained by NBC News.

The suit cites measures such as the expansion of association plans, attempt to eliminate cost-sharing reduction payments, reduction of funds for navigator programs, reducing the Open Enrollment Period, and urging the court to remove pre-existing condition protections.

The lawsuit seeks to stop practices that allow ACA exchanges to strip tax credits from enrollees with no notification, increase oversight of brokers, and strengthen oversight of the law.

“The overall picture here is one of sabotage that drives up the rates of uninsured and underinsured and leaves cities and counties holding the bag,” said Adam Grogg, senior counsel at Democracy Forward and the lead litigator in the lawsuit.

Trump Administration Allows 12-Month Short-Term Plans
August 1, 2018

The Trump administration released a final rule today on new short-term health insurance policies, which will go into effect in October.

The rule extends the current 90 days of coverage up to 12 months, and policies have the option to be renewable for a maximum of three years.

Premiums for the short-term policies could cost half as much as comprehensive coverage. However, these policies have the choice to skirt many Affordable Care Act provisions, such as coverage for maternity care, prescription drugs, or mental health care. These plans can also set annual and lifetime caps on benefits, deny coverage, or charge more for people with pre-existing conditions.

“We make no representation that it’s equivalent coverage,” said James Parker, a senior adviser to Health and Human Services Secretary Alex Azar. “These policies will not necessarily cover the same benefits or extend coverage to the same degree, but what we do know is that there are individuals today who have been priced out of coverage because of the way the ACA has been implemented and the effects that it’s had on the market.”

Critics fear the availability of the plans could cause ACA premiums to rise due to lower enrollment. An analysis by lobbying group America’s Health Insurance Plans estimates a 1.7 percent increase next year due to the short-term plan expansion.

The administration estimates that about 600,000 people will enroll in a short-term plan next year. Of that 600,000, officials estimate between 100,000 and 200,000 people will switch from ACA plans to enroll in short-term options.

Plans could be available in about 60 days but first must be approved by insurance regulators.

Report: Individual Insurance Enrollment Dropped by 12%

Enrollment in individual health insurance policies declined by 12 percent to 14.4 million in the first quarter of 2018 as compared to 2017, according to a new analysis from the Kaiser Family Foundation.

The study indicates that Affordable Care Act premium increases for unsubsidized enrollees was a key factor in the decrease, with 38 percent of people who were not eligible for subsidies dropping their coverage.

Even with the drop-off, overall enrollment in plans sold on the ACA exchanges continues to be stable, with 10.6 million enrolled compared to 10.3 million this time last year.

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