Tag Archives: ACA

Judge says U.S. is on the hook for Obamacare subsidies for insurers

The federal government had a clear obligation to reimburse insurers for assistance provided to low-income people under the Affordable Care Act, a federal judge says.
By ROBERT PEAR / The New York Times
A federal court ruled this month that a Montana insurer is entitled to federal compensation for subsidy payments under the Affordable Care Act (ACA) that President Donald Trump abruptly ended in October, a ruling that could reverberate through insurance markets and cost the government hundreds of millions of dollars.
At issue are payments for cost-sharing reductions, discounts that enhance the value of health-insurance policies purchased from the ACA’s marketplaces by reducing deductibles, co-payments and other out-of-pocket costs for low-income consumers. Trump ended the payments in October, one of a series of executive actions intended to undo President Barack Obama’s signature domestic achievement.
But Judge Elaine Kaplan of the U.S. Court of Federal Claims ruled this month that Trump’s actions violated a government promise to insurance companies participating in the health law. Although Congress never explicitly provided money for the subsidies, the court said, the government had a legal obligation to pay them.
The decision could have broad ramifications for health insurers. Several similar cases are pending in the Court of Federal Claims, a specialized tribunal that handles a wide range of monetary claims against the government. In April, another judge, Margaret Sweeney, certified a class action that allows insurers as a group to sue the government over Trump’s termination of the cost-sharing payments.

Will Congress vote away pre-existing exclusions?

From AP 6/14/18, click here for full story

The media  has grasped onto recent Trump administration statements as being aimed at pre-existing conditions.  At issue is Attorney General Jeff Sessions’ recent decision that the Justice Department will no longer defend key parts of the Obama-era Affordable Care Act in court. That includes the law’s unpopular requirement to carry health insurance, but also widely supported provisions that protect people with pre-existing medical conditions and limit what insurers can charge older, sicker customers.”

The truth here is that it is unlikely that anyone would want to go back to being stuck in a job because of medical coverage.  The truth here is that the law has many interlocking parts, so allowing one piece to be abolished may have other consequences (Kind of lick all decisions we make as humans!).

It appears that the administration is refusing to defend parts of the law related to mandated employer coverages.  While large employers would have no problem, it could affect employers with less than 50 employees IF such a change was ever made.  IF such a change was made – the courts threw out a section that affected it, it would be a simple thing for Congress to fix it.  Based on track record on other simple issues, however, this writer IMHO doubts they could get over their partisan paralysis and get much of anything done.

 

So what, exactly, did Trump eliminate on the Subsidies?

The President, in signing an executive order this past week, stopped all payments for Cost-sharing Subsidies.  Now, in a language most of you can understand:

  1.  This does not eliminate subsidies.  The Government is continuing to pay these and apparently will continue
  2. “Cost-sharing Subsidies” are only received by those on Silver plans below 250% of the Federal Poverty Level
  3. The plans are already filed and pre-approved.  Enrollees will continue to receive the same benefits as the contracts are not being changed.
  4. The Insurance company is not being paid their portion of the cost-sharing subsidies.

So in the end this affects the Insurance Carriers but not the enrolled person.  Many Insurance Carriers have already increased their premiums for 2018, based on warnings by the States that this would happen.  So in the end it may not mean much, except we all know the premiums are going up for 2018.

 

MEANWHILE – back in court, Attorney GEnerals in more than a dozen states, led by NY and CA, filed suit to get an injunction and prevent this from happening.  Given the recent rulings by these courts it is likely that they will win, at least temporarily.  It also seems to have stimulated Congress to discuss this, and perhaps even try and fix it.  At the center of the move is the argument that this is an expense that Congress never authorized.

Republicans just released a new healthcare bill — here’s what’s in it

committee on the budget logo

Business Insider
By: Bob Bryan
July 13, 2017

Senate Republican leadership released the updated version of its healthcare bill on Thursday, but continued pushback from its own conference likely puts the legislation in the same perilous position as previous iterations.

Read more ...

Employer Mandate Penalties are coming!

1095-C Form

Many employers have wondered, since they haven’t heard anything about those 1094/5 forms, if the IRS had decided not to follow up on the mandate.

Read more ...

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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