Tag Archives: ACA

CHANGES to Obamacare Plans for 2020

Health and Human Services recently released an update on 2020 rules. Only a few changes that directly affect customers.

In addition to a bunch of internal changes (lowering exchange fees and risk adjustment models for example), here are the significant differences for next year:

  1. Cost-sharing amounts paid for RX manufacturer coupons will no longer count towards meeting your out of pocket maximum. Consumers use these to reduce their copays. Medicare and Medicaid consider them kickbacks and ban them, and states are moving to do the same where a generic equivalent exists. This is designed to force people into using generic drugs.
  2. Adjusting for inflation the Out of Pocket maximum on any plan for 2020 to $8,150 indiviual ($16,300 family).
  3. Increasing the training of ACA navigators.
  4. The creation of a new Special Enrollment Period for any household with income loss that would newly be eligible for subsidies.

Medicare for All

Its clear that Bernie Sanders is making “Medicare for All” the keystone in his push for the 2020 Democratic Nomination. The topic of guaranteeing health care for all Americans is popular so its a smart move on his part, and makes for easy sound bites.


“Together we are going to end the international embarrassment of the United States of America, our great country, being the only major nation on earth not to guarantee health care to all as a right,” Sanders said. “This is a struggle for the heart and soul of who we are as American people.” “Health care is a human right, not a privilege,” Sanders said at a Capitol Hill rally Wednesday.

The real battle here is about logistics and cost, however. you don’t hear much about that on the nightly news or the late-night talk shows. Most estimates, including democratic ones, indicate it ” could increase government spending on health care by more than $25 trillion. ” The liberterian Mercatus Center puts the price tag at 32.6 trillion over ten years. Sanders claims that the higher taxes paid by all would be balanced by what you would save on premiums and high deductibles. This discounts the fact that about 85% of the population has claims less than $2000 every year; they will still be paying much higher taxes.

The White House described the plan as a “total government takeover of health care that would actually hurt seniors, eliminate private health insurance for 180 million Americans, and cripple our economy and future generations with unprecedented debt.” The president has vowed the GOP will be the “party of great health care,” but has not provided a plan of his own.

Unfortunately, no one on either side has yet proposed any legislation that would be functional, reasonable priced, and actually solve some of the biggest issues in health care costs- prescription drug costs, fraud and skyrocketing malpractice costs. Our system is clearly broken, and cannot be fixed by soundbites, political parties or sweeping statements. IMHO its time this country figured this out.

Can selling across state lines work?

The Washington Post reports that “The Trump administration is seeking ways to allow more health insurance plans to be sold across state lines — an effort that could involve implementing a part of the Affordable Care Act the Obama administration left untouched.

“The Centers for Medicare and Medicaid Services invited insurers and other stakeholders to give input over the next 60 days on how to “eliminate regulatory, operational and financial barriers to enhance issuers’ ability to sell health insurance coverage across state lines” in a request for informationissued yesterday afternoon.”

The problem, IMHO, is two-fold. Rates vary state to state because different states have different mandated benefits, the people in their pool have varying levels of health, and the costs for healthcare vary greatly state to state.

As an example, a hernia repair in Iowa averages $6900, while in NY it is 15% higher at $7900. Would your insurance bought in another state pay the local usual and customary rate? if so you will have $1000 uncovered, and MD’s might drop the plan due to lower reimbursement rates. OR would they pay the higher rate, therefore having to raise the premiums to cover these higher costs?

And if the rates all rise to meet the more expensive costs of healthcare, what have we accomplished? This is a very complicated topic, and sound bites on the nightly news are not solutions. Our system remains badly broken and in need of a comprehensive solution – one that actually controls costs, doesn’t drive physicians away, provides americans with access to care, and at a reasonable cost.


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.

 

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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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