About kristy

This author has not yet filled in any details.
So far kristy has created 44 blog entries.

GOP ability to dismantle health law expires at month’s end

WASHINGTON (AP) — Senate Republicans will soon run out of time to rely on their slim majority to dismantle the Obama health law.

The Senate parliamentarian has determined that rules governing the effort will expire when the fiscal year ends Sept. 30, according to independent Sen. Bernie Sanders of Vermont, the ranking member of the Senate Budget Committee. The rules allow Republicans to dismantle President Barack Obama’s health care law with just 51 votes, avoiding a filibuster.

“Today’s determination by the Senate parliamentarian is a major victory for the American people and everyone who fought against President Trump’s attempt to take away health care from up to 32 million people,” Sanders said in a statement. Sanders heads up Democrats on the budget panel and took the lead in the arcane arguments before the parliamentarian, who acts as the Senate’s nonpartisan referee.
Republicans control the Senate 52-48 and were using the special filibuster-proof process in the face of unified Democratic opposition. Now, if Republicans can’t revive the repeal measure in the next four weeks, they will be forced to work with Democrats to change it.

Senate Republicans pulled the plug on their Obamacare repeal effort in July, after falling short in a key vote. It has languished since, despite President Donald Trump’s call for senators to keep trying.

The ruling by Parliamentarian Elizabeth MacDonough is likely the final nail in the coffin, since it means Republicans would have to revive the effort and wrap it up in just a few weeks. Congress returns to Washington next week to face a packed agenda including Harvey aid, a temporary government-wide funding bill, and the need to raise the government’s borrowing authority to prevent a default on U.S. payments and obligations.

The bitter battle – and the struggle among Republicans – over health care consumed the early months of Trump’s presidency. It wasn’t immediately clear whether Friday’s announcement might prompt Republicans to make one final push on health care.

The focus may instead shift to a bipartisan effort by Sen. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., to shore up the insurance market. That effort faces major obstacles, too.

Many in the administration and its allies in Congress are eager to turn the focus to overhauling the tax code.

4 Million Americans Paid $2.8 Billion in Obamacare Penalties Through April 2017

Fewer Americans paid penalty after Trump’s executive order suggested IRS could grant exemptions

BY: Ali Meyer
August 22, 2017 1:00 pm

Four million Americans paid $2.8 billion in Obamacare penalties for not having health insurance on target year 2016 returns through April 27, 2017, according to data from the Taxpayer Advocate Service, a division of the Internal Revenue Service.

Beginning in 2014, the Affordable Care Act’s individual mandate required Americans to purchase health care coverage or pay a penalty to the IRS.

At that time, individuals without insurance had to pay either a flat fee of $95 or 1 percent of the household’s adjusted gross income in excess of the threshold for mandatory tax filing, whichever was greater. In 2016, those numbers increased to a flat fee of $695 or 2.5 percent of the gross income.

The report finds that this number increased again, as the 4 million individuals paid an average penalty of $708.

On President Donald Trump’s first day in office, he signed an executive order to minimize the economic burden of the Affordable Care Act, which meant the IRS could waive the individual mandate penalty.

“The order stated that the agencies should exercise all authority and discretion to waive, defer, grant exemptions from, or delay the implementation of any requirement of the Act that would impose burden,” the taxpayer advocate explains.

This means individuals were allowed to either forego checking a box that indicated they had health care coverage, complete a form to show they were exempt from the penalty, or self-assess a penalty on their return. These types of tax returns are described as “silent” returns by the IRS.

Less than a month after Trump’s executive order was signed, the IRS decided to begin rejecting these “silent returns.”

According to the taxpayer advocate’s data, the number of people who decided to pay a penalty declined 28.6 percent over the year. In target year 2015 through April 28, 2016, there were 5.6 million Americans who paid the penalty. In target year 2016 through April 27, 2017, 4 million Americans paid the penalty.

In addition, the number of silent returns increased by 200,000 in a year. In target year 2015, there were 7.8 million silent returns and in target year 2016 that increased to 8 million.

“The IRS is in the process of assessing various options to address silent returns filed in past as well as future filings, including the reinstatement of the plans to reject electronically filed silent returns, the issuance of educational or soft notices, and the issuance of penalty assessment notices,” the taxpayer advocate says.

“The National Taxpayer Advocate supports any efforts to reinstate plans to reject electronically filed silent returns as well as issue educational and soft notices,” the report states. “These options would help the taxpayer avoid future compliance problems.”

ACA’s Bare County Problem Largely Resolved As Centene Agrees To Sell Plans In Nevada.

Obamacare’s Bare County Problem Looks Mostly Solved, for Now

A few months ago, it looked as if large swaths of the country might end up without any insurers willing to sell Obamacare insurance in 2018. But in the last few weeks the “bare county” problem, which President Trump had cited as a sign the markets were failing, has nearly solved itself.

On Tuesday, Gov. Brian Sandoval of Nevada announced that Centene would offer insurance in 14 rural counties of Nevada that had been bare. That leaves only two counties in the country without insurers saying they will sell coverage; fewer than 400 Obamacare customers live in those counties.

The bare county problem had been a sort of unplanned policy hole in Obamacare, which depends on private companies to provide insurance to people who don’t get coverage through a government program or work. The federal government provides subsidies on a sliding scale to help middle-income Americans pay their premiums, but it doesn’t do anything to force insurers to offer coverage if they don’t want to. For a while, it seemed there would be a smattering of mostly rural places in the country where no company saw a reason to participate in 2018.

Read Full Article Here

Nevada Businesses face volatile insurance market

More Small Businesses Considering Providing Employee Coverage In Nevada’s Uncertain Insurance Market.

The Northern Nevada Business Weekly (8/14, Sabo) reports that the Trump Administration’s efforts “to repeal and replace the Affordable Care Act,” combined with the decisions of Anthem and Prominence Health Plan to withdraw from offering individual coverage, have unsettled Nevada’s insurance markets. The article says “as individual plans dry up and rates spike,” more small businesses are inquiring about providing healthcare coverage for employees, with one benefit solutions consultant saying, “Employer plans are the only place they can get decent rates and access.” The consultant also indicated that “the National Association of Health Underwriters is working daily to help the current administration in Washington draft legislation that would stabilize the volatile health insurance marketplace.” The article quotes NAHU Chief Executive Officer Janet Trautwein as saying in a March press release, “We look forward to continuing our dialogue with members of Congress and the administration on the implementation of health care reforms that reduce cost and encourage competition.”

Anthem to pare back Obamacare offerings in Nevada and Georgia

(Reuters) – U.S. health insurer Anthem Inc (ANTM.N) said on Monday it will no longer offer Obamacare plans in Nevada’s state exchange and will stop offering the plans in nearly half of Georgia’s counties next year.

The moves come after Republican senators last month failed to repeal and replace Obamacare, former President Barack Obama’s signature healthcare reform law, creating uncertainty over how the program providing health benefits to 20 million Americans will be funded and managed in 2018.

Hundreds of U.S. counties are at risk of losing access to private health coverage in 2018 as insurers consider pulling out of those markets in the coming months.

Nevada had said in June that residents in 14 counties out of 17 in the state would not have access to qualified health plans on the state exchanges. Anthem’s decision to leave the state entirely does not increase the number of “bare counties” in the state, Nevada Insurance Commissioner Barbara Richardson said in a statement.

The insurer will still offer “catastrophic plans,” which can be purchased outside the state’s exchange and are only available to consumers under 30 years old or with a low income.

Anthem also said it will only offer Obamacare plans in 85 of Georgia’s 159 counties. It said the counties it will continue to offer the plans in are mostly rural counties that would otherwise not have health insurance coverage for their residents.

It said these changes do not impact Anthem’s Medicare Advantage, Medicaid or employer-based plans in either state.

The company said last week that it will pull out of 16 of 19 pricing regions in California in 2018 where it offered Obamacare options this year.

Anthem blamed the moves in part on uncertainty over whether the Trump administration would maintain subsidies that keep costs down.

U.S. President Donald Trump last week threatened to cut off subsidy payments that make the plans affordable for lower-income Americans and help insurers to keep premiums down, after efforts to repeal the law signed by his predecessor, President Barack Obama, failed in Congress.

Trump has repeatedly urged Republican lawmakers to keep working to undo Obama’s Affordable Care Act.

Nevada governor vetoes Medicaid-for-all bill

By David Montero | Los Angeles Times

There will be no Medicaid-for-all option in Nevada.

Gov. Brian Sandoval waited until the last day he could — Friday — to veto a measure that would have offered a state-sponsored health insurance option to all residents regardless of income. If he hadn’t signed it or vetoed it by midnight, it would have become law.

Had the Republican governor signed it, however, Nevada would have become the first state to attempt a Medicaid-for-all approach to health insurance. It also would have placed Nevada among the ranks of states including California that are looking for ways to solidify health insurance options for populations that will be risk if Congress and President Trump gut the Affordable Care Act.

In his three-page veto message released Friday night, Sandoval praised the sponsor of the bill for “creativity” in attempting to design a healthcare option for the state’s 2.9 million people, but he ultimately reasoned that there were too many unanswered questions about how the program would work.

He wrote that the legislation was “an undeveloped remedy to an undefined problem” — and that it didn’t get proper scrutiny before it was passed in a short time frame.

The bill was short — just four pages — and its sponsor, Democratic Assemblyman Mike Sprinkle, acknowledged that it would require a lot of work if it had become law. That’s why, Sprinkle said, he put an implementation date of January 2019 within the bill’s text.

In a statement, he expressed disappointment by the governor’s veto.

“Healthcare is a right, not a privilege or a product. With this veto, Governor Sandoval has actively decided to veto a right that all Nevadans should have,” Sprinkle said. “I won’t give up on the fight to secure access to quality and affordable healthcare for every Nevadan — I will bring this legislation back next session.”

The measure proposed selling a Medicaid-style insurance option on the Silver State Health Insurance Exchange. Called the Nevada Care Plan, it would have been sold alongside private insurance options. It would have operated within Medicaid, but it wouldn’t be Medicaid — the latter has strict qualifications targeting low-income families.

There were worries among providers — including the Nevada Hospital Assn. — about the Nevada Care Plan reimbursing them at lower rates than the private insurance plans pay. There were also concerns — also mentioned by the governor — of the plan disrupting the current marketplace.

The legislation also faced a significant hurdle in that there would be no way for the Nevada Care Plan to be sold on the Silver State Health Insurance Exchange. The plan would also have needed permission from the federal government for consumers to use federal income tax credits to purchase it.

Sprinkle had said part of his reason for proposing the legislation was related to the uncertainty in Washington about the fate of Obamacare, which congressional Republicans and Trump have sought to repeal.

The House of Representatives successfully passed a bill to replace Obamacare, but Senate Republicans are crafting their own plan to do away with President Obama’s signature achievement.

One of the chief worries for states like Nevada centers on what will happen to people who obtained health coverage under the expansion of Medicaid under Obamacare. Medicaid is a federal-state program that helps pay for healthcare for needy, elderly, blind and otherwise disabled people and for low-income families with children.

Sandoval was one of the few Republican governors to accept Obamacare’s Medicaid expansion, and Sprinkle thought his bill might have a chance to get the governor’s signature given Sandoval’s vocal opposition to congressional moves to repeal Medicaid expansion.

In his message, the governor said the proposal — dubbed Sprinklecare — “does not end the conversation about potential coverage gaps or possible solutions, including Medicaid-like solutions.”

Nevada has about 600,000 people using Medicaid and the Medicaid expansion. About 11% of Nevada residents remain without any healthcare coverage.

“Given the possibility that changes in federal law may put Nevada’s expanded Medicaid population at risk of losing their coverage, the ability for individuals to purchase Medicaid-like plans is something that should be considered in depth,” Sandoval wrote. “If done correctly, the proposals in AB374 could provide a necessary safety net for those who may no longer have access to traditional Medicaid.”

Sandoval is term-limited and cannot seek reelection in 2018.

Aetna reverses course, may offer ObamaCare policies in Nevada

Nearly 2M fell off Obamacare coverage rolls through mid-March

By Rachana Pradhan | POLITCO

The number of Americans insured under Obamacare fell by nearly 2 million people between Jan. 31 and mid-March, according to new CMS data that found about 10.3 million still were covered through health law exchanges.

The decline reflects customers failing to pay premiums after they selected plans during the most recent open enrollment period. Roughly 12.2 million people had selected private plans through the federal HealthCare.gov exchanges and the state-run marketplaces that operate in about a dozen states as of the Jan. 31 deadline to sign up.

CMS said high costs and lack of affordability were the most common factors individuals cited when asked why they didn’t keep their coverage. A separate report on enrollment trends attributed the drop-off to other factors, including securing a job with employer-sponsored insurance.

The 10.3 million covered individuals include those who selected a plan that began in January or February and had paid their first month’s premium.

Enrollment attrition also occurred during the Obama administration, though reporting periods varied. Roughly 11.1 million people were enrolled in Obamacare plans at the end of March 2016, down from the 12.7 million people who signed up during the previous enrollment period.

The new report comes amid continued troubling news about health law insurance markets, including Anthem’s decision this month to pull out of Ohio’s Obamacare marketplace, potentially leaving 10,500 customers in 18 counties without any insurance options for 2018. Republicans in Congress have cited coverage gaps and other problems as justification for repealing the health law.

Sign-ups for Obamacare coverage declined for the first time in the 2017 season and fell below the Obama administration’s estimates for the three-month enrollment window that ended in January, according to federal data.

The Trump administration scrapped phone calls and other forms of outreach to encourage sign-ups in the finals days of the enrollment period, then reversed itself after the move sparked outcry from the law’s supporters and health insurers. Officials said they were unable to pull back some HealthCare.gov radio and TV advertising that had been purchased by the Obama administration. HHS was able to cancel about $4 million to $5 million in ads.

Mayo to give preference to privately insured patients over Medicaid patients

Pushback on Medicaid, Medicare part of a trend.
By Jeremy Olson Star Tribune

Mayo Clinic’s chief executive made a startling announcement in a recent speech to employees: The Rochester-based health system will give preference to patients with private insurance over those with lower-paying Medicaid or Medicare coverage, if they seek care at the same time and have comparable conditions.

The number of patients affected would probably be small, but the selective strategy reveals the financial pressures that Mayo is facing in part due to federal health reforms. For while the Affordable Care Act has reduced the number of uninsured patients, it has increased the share covered by Medicaid, which pays around 50 to 85 cents on the dollar of the actual cost of medical care.

Mayo will always take patients, regardless of payer source, when it has medical expertise that they can’t find elsewhere, said Dr. John Noseworthy, Mayo’s CEO. But when two patients are referred with equivalent conditions, he said the health system should “prioritize” those with private insurance.

“We’re asking … if the patient has commercial insurance, or they’re Medicaid or Medicare patients and they’re equal, that we prioritize the commercial insured patients enough so … we can be financially strong at the end of the year to continue to advance, advance our mission,” Noseworthy said in a videotaped speech to staff late last year. The Star Tribune obtained a transcript of the speech, and Mayo has confirmed its authenticity.

Mayo is hardly alone in trying to build its privately insured clientele. Hennepin County Medical Center, for example, is building a new ambulatory center and North Loop clinic in part to attract privately insured patients.

But in the diplomatic world of health care and politics, it is rare to hear a hospital leader espouse any strategy that promotes access for privately insured patients at the expense of publicly funded patients.

“The most interesting thing isn’t that it’s happening, it’s that a high level executive actually said it out loud,” said Mat Keller, who monitors health care policy and hospital finances for the Minnesota Nurses Association.

Noseworthy declined via Mayo spokespeople to be interviewed for this story. Spokesman Karl Oestreich said Mayo remains committed to publicly funded patients — who make up half the health system’s business — even with the new policy.

“We can provide the care they require for complex medical issues,” he said. “However, we need to balance requests from these patients with their specific needs — if it’s necessary for them to come to Mayo — as well as the needs of commercial paying patients.”

Read Full Article Here

IRS To Pull Back On Enforcing ACA’s Individual Mandate For Coverage.

IRS won’t withhold tax refunds if Americans ignore ACA insurance requirement

By Amy Goldstein February 15 – The Washington Post

The Trump administration is taking its first steps to put its imprint on the Affordable Care Act, reversing plans to withhold tax refunds this year from Americans who flout an insurance requirement in the law while proposing a series of rule changes to encourage insurers to remain in ACA marketplaces.The Internal Revenue Service has revoked an Obama-era instruction to taxpayers that was taking effect during the current filing season as a way to further compliance with the ACA’s requirement that most Americans carry health insurance or pay a tax penalty. Under the instruction, the IRS had announced that it would no longer process tax returns for people who fail to send a notice with their returns that they have insurance, are exempt from the requirement or are paying the fine.Instead, the agency said in a statement on Wednesday, tax returns will be processed as always, even for individuals who do not provide the required information. The IRS said the decision, made earlier this month but not previously publicized, was in line with an executive order that President Trump signed hours after his inauguration, giving agencies broad authority to lighten the burden of federal rules under the ACA.The IRS confirmed the change on the same morning that Health and Human Services officials proposed a set of rules to help protect insurers and shore up ACA marketplaces in the short term while Republicans work on demolishing the law. The proposal drew swift praise from the insurance industry and condemnation from consumer advocates and congressional Democrats.

Taken together, the moves by the IRS and HHS demonstrate the balancing act the fledgling administration is attempting with the 2010 law, which remains one of Trump’s top targets. The administration is eager to undermine as much of the ACA as it can through executive actions, but it also is eager to stave off any abrupt collapse of the insurance marketplaces covering about 10 million people — and to minimize any political fallout for the GOP.

While allowing tax refunds to keep flowing, the IRS change does not affect the actual penalty most people face for not having health coverage, which can be eliminated only through a new law. The penalty is $695 per adult or 2.5 percent of a household’s income, whichever is greater.

The proposed HHS rule would make it harder for consumers to buy health coverage outside of the law’s regular enrollment periods, give insurers power to deny new coverage to people late in paying their premiums, and create more rigorous checks of applicants’ eligibility.

At the same time, the changes would eliminate federal reviews of whether health plans in the ACA marketplaces have enough doctors and other providers of care, delegating the task to states. And by lowering how much insurers must pick up for a specific benefit package, the changes would allow them to sell plans with higher deductibles.

Read Full Article Here