Author Archives: Reeve Conover

Texas recoups $839 MM from illegal Obamacare tax

AG Paxton Wins Multistate Obamacare Tax Lawsuit, Recoups Over $839 Million, Including Nearly $305 Million For Texas Taxpayers
MARTY SMITH / STL News
Texas Attorney General Ken Paxton today commended a U.S. District Court decision ordering the Internal Revenue Service to repay Texas and five other states more than $839 million because of an unlawful Obamacare tax on state Medicaid programs. Of that total amount, Texas stands to be repaid $304,730,608.
“Obamacare is unconstitutional, plain and simple,” Attorney General Paxton said. “We all know that the feds cannot tax the states, and we’re proud to return this illegally collected money to the people of Texas.”
In October 2015, Attorney General Paxton led a multistate lawsuit against the federal government over the Obama-era regulation that threatened to choke off Medicaid funds for the health needs of millions of Texas citizens unless Texas taxpayers paid a portion of the Health Insurance Providers Fee to help fund Obamacare.

CIGNA to merge with Express Scripts

Cigna Corp (CI.N) shareholders on Friday voted in favor of the health insurer’s proposed $52 billion acquisition of pharmacy benefit manager Express Scripts Holding Co (ESRX.O), although the deal still needs clearance from antitrust authorities.

The U.S. Department of Justice is still conducting an antitrust review of the combination that is not expected to close until later this year.

According to the preliminary results, about 90 percent of the votes cast were in favor of the merger, the health insurer said.

Cigna expects the merger to close by end of 2018.

Google invests in Oscar Health Plans

From Oscar on August 16, 2018:

we are thrilled to announce that Google’s parent company, Alphabet, is planning to invest $375 million in Oscar.

Alphabet has been a supporter of Oscar for years and this reflects an incredible vote of confidence in Oscar’s unique ability to deliver a consumer-focused, tech-driven member experience in health care. This investment will allow Oscar to continue to invest in and bring Oscar’s unique product to more people, markets, and business lines. For more details, check out our CEO Mario’s interview in the Wired story: Health Care is Broken. Google Thinks Oscar Health Can Fix It.

Why Montefiore Health System leaving Aetna affects Rockland, Westchester patients

Montefiore Health System sites across the Lower Hudson Valley may soon be considered out-of-network for patients with the Aetna health plan.

The planned change would take effect Sept. 8. The Montefiore sites include White Plains Hospital, its hospitals in New Rochelle and Mount Vernon, as well as Nyack Hospital.

The Journal News/lohud obtained a letter sent to Aetna clients about Montefiore becoming out-of-network, which would increase what they pay for health care at the Montefiore sites.

 

Click here for the full story

ASSOCIATION HEALTH PLAN (AHP) FINAL RULES ISSUED

On January 4, 2018, the U.S. Department of Labor (DOL) announced proposed rules to expand the
opportunity to offer employment-based health insurance to small businesses through Association
Health Plans.

On June 19, 2018, the Trump Administration released a final rule as well as a fact sheet on the new rule.
The rule was in response to an executive order issued by President Trump on October 12, 2017 directing
federal agencies to expand the availability of AHPs, short-term limited duration insurance policies and
Health Reimbursement Arrangements. The proposal calls for a revision to ERISA in order to redefine
“employer” to allow more groups to qualify as associations and treat health coverage sponsored by an
employer association as a single group health plan that would not be subject to the ACA’s ten essential
health benefits required in the consumer and small group markets.

The goal of the Administration’s rule is to provide small-business owners, employees of small businesses and
family members of working owners and their employees with more coverage options, more affordable pricing,
enhanced ability to self-insure, less regulatory burden and complexity and reduced administrative costs.

HOW
Under the final rule, self-employed individuals, sole proprietors and common-law employees would be
permitted to join an AHP.
The final rule does say that there must be at least one other service, e.g., education, offered to members
so that the association cannot solely exist to provide health insurance. Allowing the self-employed without
employees to join is beneficial as they were excluded in 2014 when they could no longer get group coverage,
but there is a risk of anti-selection. It was suggested that they should have one open enrollment season to
avoid any anti-selection. Although the final rule does not mandate one enrollment period, it does allow the
association to incorporate the suggested rule.

State laws are not preempted, which means the final rule will apply to them.

REGIONAL STATE REVIEW
New York State DFS (New York State Department of Financial Services) has reported that the Trump
Administration’s final rule expanding the role of association health plans won’t prevent its authority to
regulate health insurance.

New Jersey DOBI (New Jersey Department of Banking and Insurance) has reported that it will not allow
non-compliant plans.

Delaware currently allows a Delaware-based employer to participate in an association plan from another
state if that state allows it and the Delaware group is a member of that association.

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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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