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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

President Trump’s ACA Executive Order

National Assocaition of Health Underwriters

Just hours after President Trump was sworn into office there was breaking news about the president’s executive order (EO), “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal.” According to the text of the order, it charges the departments and agencies associated with the enforcement of the Affordable Care Act (ACA) to ease the burden of the ACA as we transition to repeal and replace.

The EO did not repeal any part of the ACA and does not directly mention any legislation or regulation that President Trump is directing to be eased, repealed, rescinded or amended. The order serves to re-enforce the power Congress, the departments and agencies already have to move towards change through legislation and regulation. However, NAHU sees this as an opportunity for us to use the presidential message of support for change to continue our advocacy efforts with both Congress and the administration’s agencies to focus on marketplace stability.

We will continue to update you as any other EOs, legislation or regulations are released. In the meantime, all statutes and regulations enacted by the ACA continue to be in place and NAHU members should continue to work with their clients to be in compliance with the law.

NAHU: Using A Broker May Help Consumers Deal With Rising Healthcare Costs

In a piece for The Baltimore Sun  (9/26) CEO of the National Association of Health Underwriters Janet Trautwein writes that “a recent report warned that Marylanders may see premiums on the state health exchange surge by 20 percent next year.” Trautwein suggested that consumers “should seek help from insurance agents and brokers” in order to learn about different plans. She says, “using an agent often yields significant savings — premiums are 13 percent lower in counties with the most brokers.”

How to deal with rising health care costs

A recent report warned that Marylanders may see premiums on the state health exchange surge by 20 percent next year (“Marylanders face hefty rate increases for Obamacare,” Sept. 12).

Many Marylanders may look to switch plans. But before wading through a swamp of information on their own, consumers should seek help from insurance agents and brokers.

Consumers can learn about different plans from these professionals, who have an average of 10 years experience. Using an agent often yields significant savings — premiums are 13 percent lower in counties with the most brokers.

Janet Trautwein, Washington, D.C.

Family Caregivers Considered Indispensable


Family Caregivers Considered Indispensable As America’s Elderly Population Increases.

The Wall Street Journal (6/3, Levitz, Subscription Publication) reported that advocates and lawmakers are seeking more ways to help millions of unpaid family members who allow many elderly Americans to age in place and reduce the strain on programs such as Medicaid. Kathy Greenlee, assistant secretary for aging at HHS, said, “Families have always been the backbone of our system for caring for people. … Really, if we didn’t have them, we couldn’t afford as a country to monetize their care and we couldn’t replace, frankly, the love they provide to family members.”

AARP estimates some 40 million caregivers in the US provided $470 billion worth of unpaid care to adults with illnesses in 2013.

UnitedHealthcare plans to remain in three state exchanges in 2017

The insurance giant is planning to compete in just Nevada, New York and Virginia in 2017.

By Christopher Snowbeck Star Tribune


The extent of UnitedHealthcare’s exit from the nation’s health insurance exchanges became clearer Wednesday as the company said it plans to compete in government-run marketplaces for just three states next year.

Currently, United competes on the exchanges for 34 states but is retreating due to large financial losses.

United signaled late last year that a pullback was coming and updated the commentary in April by saying the insurer would remain in just a “handful” of states.

On Wednesday, a United spokesman confirmed the insurer plans to compete again next year only on the exchanges in Nevada, New York and Virginia, suggesting the company won’t be back in 31 other states.

“The individual on-exchange products filed for 2017 … may not be available in all service areas within the states referenced,” the insurer said in a notice posted to a website for brokers.

The exchanges are an option for individuals and families to obtain health insurance outside of employer groups and government programs. The online marketplaces were launched under the federal Affordable Care Act, which requires almost all Americans to have health insurance or pay a tax penalty.

UnitedHealthcare never sold policies through Minnesota’s MNsure exchange, but the insurer is an option for exchange shoppers in the neighboring states of Iowa and Wisconsin.

One carrier leaving so many state markets isn’t necessarily a huge deal in isolation, since in most cases consumers will still have choices, said Robert Laszewski, a health care consultant in Virginia. But United’s actions point to broader problems with the exchanges, Laszewski said, including financial losses for carriers, rising premiums for consumers and many potential subscribers opting out of coverage.

“If you look at in the broader sense, [it’s] just another example of the Obamacare exchanges having terrible results,” Laszewski said.

But Cynthia Cox, a researcher with the Kaiser Family Foundation, said she sees United’s moves as a response to its own difficult experience on the exchanges, rather than a statement about the overall health of the government-run marketplaces.

Cox noted that United’s independent subsidiary Harken Health will continue in Georgia and Illinois, while expanding to Florida, and suggested the insurer might simply be experimenting with a new strategy.

“It doesn’t seem like other insurance companies are following suit,” she said. “Some other insurers have found ways to be profitable on the exchanges, or at least have had better financial outcomes than United did.”


ACS Insurance, Provides choices in quality insurance and financial solutions for all Nevada residents.

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New Concerns for Obamacare


Insurance rates going up: New concerns for Obamacare

WASHINGTON (AP) — Fresh problems for “Obamacare”: The largest health insurer in Texas wants to raise its rates on individual policies by an average of nearly 60 percent, a new sign that President Barack Obama’s overhaul hasn’t solved the problem of price spikes.

Texas isn’t alone. Citing financial losses under the health care law, many insurers around the country are requesting bigger premium increases for 2017. That’s to account for lower-than-hoped enrollment, sicker-than-expected customers and problems with the government’s financial backstop for insurance markets.

The national picture will take weeks to fill in. With data available for about half the states, premium increases appear to be sharper, but there are also huge differences between states and among insurers. Health insurance is priced locally.

Earlier this week, North Carolina’s largest insurer said it will seek an average increase of 18.8 percent.

A recent analysis of nine states by the consulting firm Avalere Health found that average premium increases for the most popular kind of plan ranged from 5 percent in Washington state to 44 percent in Vermont.

Millions of customers will be shielded from price hikes by government subsidies, which typically cover more than 70 percent of the premiums. People who don’t have access to a workplace plan can buy a policy directly on the health law’s marketplaces.

But many consumers aren’t eligible for the income-based subsidies and get no such protection. That demographic includes small business owners, self-employed people and early retirees. Under the law, most Americans are required to have health insurance or risk being fined.

Blue Cross Blue Shield of Texas has about 603,000 individual policyholders and, unlike other insurers in the state, offers coverage in every county. In a recent filing with federal regulators, a summary of which is available on HealthCare.gov, the company said it is seeking increases averaging from 57.3 percent to 59.4 percent across its individual market plans.

In a statement, Blue Cross Blue Shield of Texas said its request is based on strong financial principles, science and data. “It’s also important to understand the magnitude of the losses … experienced in the individual retail market over the past two years,” the statement said. The company says it lost $592 million last year and $416 million in 2014.

Texas is the health care law’s third-largest market, after Florida and California. Texas state regulators said the insurer’s request is confidential and they can’t comment on it. However, Insurance Department spokesman Ben Gonzalez said the state can withdraw approval if the request doesn’t meet requirements and standards in Texas law.

Wichita Falls insurance broker Kelly Fristoe said the burden of premium increases will fall hardest on rural communities where Blue Cross Blue Shield is in many cases is the only option. Metropolitan areas like Houston, Dallas, and Austin attract more insurers.

“This is going to be a very big disrupter of the market,” said Fristoe. Some relatively healthy people “would probably be willing to roll the dice and take their chances” by dropping coverage, even if it means they might be fined.

The insurer cautioned that the average premiums filed with regulators don’t represent the true bottom line for individual consumers. Some people may find that even with a higher premium, the coverage remains a good value.

Regulators can request more information from the company, but the federal government can’t order Blue Cross Blue Shield of Texas to roll back the increases, said Larry Levitt, an expert on the health care law at the nonpartisan Kaiser Family Foundation.

“Given how much money (the company) lost, it’s likely that a substantial rate increase is merited,” Levitt said.

The Obama administration said concerns about 2017 premiums are premature and overblown.


Study: Expanding generic drug use could save billions

Drugs with different chemical structures can provide new options, researchers say

By Bradley J. Fikes | 8 a.m. May 9, 2016

Health insurers and patients could safely save many billions of dollars annually by swapping out a more expensive drug for a less expensive generic in the same class of drugs, according to a study published Monday.

The suggestion goes beyond the common practice of substituting a generic drug for a brand-name drug with the identical active ingredient. The researchers say that in many instances, a generic with a different chemical makeup, prescribed for the same disease, could work just as well. This is called therapeutic substitution

For example, a brand-name proton pump inhibitor, used to reduce acid reflux, could be replaced with a generic proton pump inhibitor with a different active ingredient. In many cases, the benefits would be the same. To pay more for the same benefit is just excess spending, the researchers say.

Excess spending of $73 billion took place between 2010 and 2012, the study concluded. Researchers examined prescription data on 107,123 patients, using the Medical Expenditure Panel Survey from the Department of Health and Human Services.

Of the total excess spending during that period, patients paid 33 percent, or $24.6 billion, out of pocket.

The study was published in JAMA Internal Medicine. It was authored by Michael E. Johansen, M.D., of The Ohio State University in Columbus; and Caroline Richardson, M.D., of the University of Michigan, Ann Arbor. It can be found at http://j.mp/drugsubs.

The most excess money was spent on statins to lower cholesterol, with an excess expenditure of $10.9 billion; and atypical antipsychotics for mental disorders, with a $9.9 billion excess. Proton pump inhibitors to reduce stomach acid incurred an extra expense of $6.12 billion; and selective serotonin reuptake inhibitors, for depression, $6.08 billion.

“A previous study showed substantial potential savings if therapeutic substitution were introduced to Medicare Part D,” the authors stated. “In addition, a nationally representative study showed high levels of branded proton pump inhibitor (PPI) use and expenditure between 2007 and 2011 when a therapeutically equivalent generic medication was available.”

Certain classes of drugs were omitted from the analysis, including some antibiotics and respiratory drugs and testosterone. Insulin was also omitted, because no generic form is available.

The study’s cost savings estimates are correct, said Jonathan Watanabe, an assistant professor in the Skaggs School of Pharmacy and Pharmaceutical Sciences at UC San Diego. Watanabe wrote his doctor of pharmacy thesis on the subject.

“It’s been demonstrated in several studies that there’s a lot of money being left on the table, because we’re not using generics as effectively as we could be,” Watanabe said.

Substitution may actually improve patient health, Watanabe said. Those who have trouble affording expensive brand-name drugs are apt to fall out of compliance, losing all benefit from the drug they never take. And that may mean greater expenses down the road, if patients are hospitalized for a condition that faithful adherence to their medications could have averted.

“If we could keep them more adherent, we could reduce health system costs,” he said.

Putting therapeutic substitution into practice will require better communication between doctors and pharmacists, and systems they use need to be redesigned, said author Johansen.

“The health care systems, the medical records systems, should be more aligned toward getting the easiest, cheapest, best drug into the patient’s hands,” Johansen said.

To do that, spreading the knowledge that pharmacists have is essential, he said.


Over One-Third Of Americans Have Received Unexpected Medical Bills.

NBC Nightly News (5/9, story 7, 2:00, Holt) reported that “over a third of Americans say they’ve been hit with jaw-dropping medical bills they didn’t know were coming.”

NBC’s Olivia Sterns highlighted the case of a woman who “got a bill for $100,000” because a surgeon “had stopped taking her insurance, and while the hospital was in network, the anesthesiologist was not.” New York State Superintendent of Financial Services Benjamin Lawsky advised those receiving such bills, “They should fight it, and they should be loud, and they should contact their attorney general in their state and insurance regulator in their state.”

FDA to prioritize reviews of generic drugs made by one company

Shkreli’s Strategy to Jack Up Drug Prices May Be Curbed by FDA

Featured in BloomberBusiness – by Anna Edney

With a small regulatory change, the U.S. Food and Drug Administration may have just stopped the next Martin Shkreli.

The agency said Friday that it will prioritize review of new applications for generic drugs that would compete with treatments made by only one company. That could help make it less profitable for somebody like Shkreli, who was until last year the chief executive officer of Turing Pharmaceuticals AG, from buying an old, patent-expired drug with no competition and jacking up the price.

At Turing, Shkreli became notorious for acquiring Daraprim, a decades-old anti-parasitic treatment, and increasing the price to $750 a pill from $13.50. Because Turing is the only company with FDA approval for the medicine, he could charge whatever he wanted. He defended the move by saying he was playing by the rules, and perhaps should have increased the price even more.

The FDA estimates the change in prioritization could expedite review of as many as 125 generic drug applications, Sandy Walsh, an agency spokeswoman, said via e-mail. The agency already prioritized review for generics that would be the first to compete with a brand-name product.

Shkreli is currently facing securities fraud charges related to a separate former company and several hedge funds that he used to run. He has maintained his innocence and pleaded not guilty. Turing fired Shkreli after his arrest. Turing and Shkreli didn’t immediately respond to requests for comment.

Old Drugs

With older drugs that have lost patent protection, the companies that originally invented them may have ceased manufacturing or sold the rights to another owner, leaving a single version to monopolize the market. Since it can take months or years to get a new version approved, whoever holds the rights in the meantime has huge pricing power.

In January, senators asked Janet Woodcock, director of FDA’s Center for Drug Evaluation and Research, whether the agency could prioritize reviews of drugs that would compete with ones made by just one manufacturer. At the time, Woodcock said that the agency will expedite a generic drug review if there’s only one manufacturer and a shortage is possible, but not because of price hikes resulting from a monopoly.

The agency collects fees from drug companies to review their applications in a timely manner. The FDA’s goal for this fiscal year is to review 75 percent of generic drug applications in 15 months, according to Woodcock’s January testimony before the Senate Health, Education, Labor and Pensions Committee. The agency received about 1,500 generic drug applications in fiscal 2014, she said.

ObamaCare gets extra sign-up period to clear tax issues

New ACA Sign-Up Period Offered To Resolve Tax Problems.

While Jan. 31 was the deadline for most people to enroll in 2016 ACA coverage, the Administration is setting up a new sign-up period “for people who failed to file 2014 tax returns,” The Hill reports. The new period “will provide another chance until March 31, for certain people who might have missed out on coverage because of confusion about new ObamaCare requirements regarding taxes and health insurance.” People who received ACA tax credits in 2014 were required to file a return “to make sure they received the right amount of credit,” and if they failed to file, “they became ineligible for further tax credits starting in 2016.” While it is “unclear exactly how many people are eligible for the new sign-up period,” CMS “said it ‘believes there are only a relatively small number of consumers who will qualify.’”

ObamaCare gets extra sign-up period to clear tax issues

By Peter Sullivan02/08/16 04:02 PM EST | THE HILL

The Obama administration is setting up a new ObamaCare sign-up period for people who failed to file 2014 tax returns.

Jan. 31 was the deadline for most people to sign up, but this new period will provide another chance until March 31, for certain people who might have missed out on coverage because of confusion about new ObamaCare requirements regarding taxes and health insurance.

People who received tax credits under ObamaCare to help them afford insurance in 2014 were required to file a 2014 tax return in order to make sure they received the right amount of credit. If people failed to file a tax return, they became ineligible for further tax credits starting in 2016.

Without the tax credits, many people would find coverage unaffordable, and would be likely to forgo coverage altogether.

This new period gives them a chance to sign up, with tax credits, if they go back and file their return for 2014.

It is unclear exactly how many people are eligible for the new sign-up period. The Centers for Medicare and Medicaid Services (CMS) said it “believes there are only a relatively small number of consumers who will qualify.”

The administration said last month that about 43,000 applicants had lost their tax credits and were now bearing the full cost of their insurance plans, as of Jan. 1, because they failed to file a 2014 tax return.