EXPANDED AND IMPROVED MEDICARE FOR ALL WILL REVERSE THESE HEALTH POLICIES! SIMPLY DEMAND YOUR STATE HEALTH SYSTEM BE MEDICARE FOR ALL!
The Affordable Care Act is so large because Obama and neo-liberals had to hide the fact that they are ending access to health care for 80% and climbing of American citizens and pushing them to a Medicaid preventative care only. This will include seniors as well as Medicare will be dismantled. Like the Financial Reform bill that was thousands of pages long-----and almost none of it implemented----the idea it to make the American people think there is something in there for them-----when there is absolutely nothing in the ACA for them. Remember, Trans Pacific Trade Pact pushes nations around the world to end their public health programs and this is what ACA does here in the US. It is a Republican policy to end public health and maximize health industry profits so don't listen to Republicans lamenting this attack on American's beloved Medicare----THEY WROTE THE POLICY FOR GOODNESS SAKE. They are playing the American people who will be literally killed from lack of access.
IF YOUR NATIONAL LABOR AND JUSTICE LEADERS SUPPORTED AFFORDABLE CARE ACT----THEY KNEW WHERE THIS WAS GOING. SO DID YOUR POLS!
GET RID OF THESE GLOBAL CORPORATE NEO-LIBERALS.
'Healthcare providers and consumer advocacy groups have complained about exchange health plans narrowing their networks to exclude a significant number of hospitals, physicians, clinics, and other providers. Plans say narrowing their networks is necessary to keep premiums affordable. The insurance industry and business groups are likely to view the new proposed rules with concern'.
Indeed, this 'narrowing' is exactly how these private health plans are going to maximize profit by excluding and making it difficult for many people to access the care they need. For example-----each plan must include pre-existing or chronic conditions but nothing says the plan cannot partner with a clinic two hours away to provide that care. Hospitals are partnering with certain insurance brands which may exclude by virtue of the high cost premiums creating a tiered system that will allow only affluent citizens access to some of the best hospitals. This was the goal of course as you can streamline operations better if access to care is income-based. In California, Illinois, and New York some of the top hospitals are now in narrow networks that allow only the affluent....and not coincidently those states are all Clinton global corporate neo-liberal. Nothing Democratic about class-specific health facilities. The rest of the world cannot believe this as nowhere else in the developed world does a government segregate health care according to income.
THAT'S WHAT A REPUBLICAN HEALTH PLAN DOES----WORKS FOR WEALTH AND POWER AND THAT IS WHAT THE AFFORDABLE CARE ACT IS ABOUT----CREATING THE WALL STREET OF HEALTH SYSTEM MONOPOLIES.
Below you see the first article that shows how all of the consumer-friendly policies in the ACA are being dismantled.The article shouts out how great this 80/20 Rule will be and I even had a Facebook discussion with someone supporting ACA and quoting this 80/20 Rule as 'putting money back into people's pockets'. Sounds great. Guess what health corporations did to respond to this early rebates of $1.1 billion------
THEY SIMPLY HID AND CREATED LOOPHOLES FOR WHAT IS CONSIDERED ADMINISTRATIVE.
All over the news was the splash------consumers getting hundreds of dollars back and today----you hear nothing because consumers are getting nothing back. It was all propaganda to make people think this wasn't all about maximizing profits for health industry.
Health insurers to pay rebates
Marylanders to get average of $143 per family
une 20, 2013|By Andrea K. Walker, The Baltimore Sun
The ACA 80/20 Rule: Provides Value and Rebates to Millions of Consumers
by Editorial Staff Jul 30 ,2012 1:15 am
The new health reform law, the Affordable Care Act, holds health insurance companies accountable to consumers and ensures that American families are reimbursed if health insurance companies don’t meet a fair standard of value.
Because of the Affordable Care Act, insurance companies now must reveal how much of premium dollars they actually spend on health care and how much they spend on administration, such as salaries and marketing. This information was not shared with consumers in the past. Not only is this information made available to consumers for the first time, if an insurance company spends less than 80% of premiums on medical care and quality or less than 85% in the large group market, which is generally insurance provided through large employers, it must rebate the portion of premium dollars that exceeded this limit. This 80/20 rule is commonly known as the Medical Loss Ratio MLR rule.
On June 1, 2012, insurance companies nationwide submitted their annual MLR reports for coverage provided in 2011 to the Department of Health and Human Services HHS. Based on this data, insurance companies that didn’t meet the 80/20 rule will provide nearly 12.8 million Americans with more than $1.1 billion in rebates this year. Americans receiving the rebate will benefit from an average rebate of $151 per household.
Under the new health care law, rebates must be paid by Aug. 1 each year. As a result, 12.8 million Americans will see one of the following:
The 80/20 rule is ensuring that insurance companies provide consumers value for their premium dollars. This rule works in combination with other consumer protections in the Affordable Care Act, like the program that reviews insurance companies’ rates to ensure that premium increases are not unreasonable. Insurance companies are now required to subject insurance premium rate increases of 10% or more to a new review process and justify these increases. Most states now have the authority to determine whether these increases are excessive, while HHS reviews rates in states that do not operate effective rate review programs. In making these determinations: HHS and the states closely review insurance companies’ 80/20 or MLR standards.
Summary of All Markets
Americans covered by insurance companies that failed to meet the MLR standard will receive an average rebate of $151 per family across all markets. The average rebate per family is expected to be $152 in the individual market, $174 in the small group market, which is generally insurance provided through small employers, and $135 in the large group market. The states with average rebates above $500 per family are: Vermont $807, Oregon $777 and Indiana $503 in the large group market; Georgia $811, Ohio $783, New York $632, Alaska $622 and Illinois $551 in the small group market; and Mississippi $651 and Alabama $582 in the individual market.
Approximately 66.7 million consumers are insured by an insurance company that provides the required value for their premium dollars. This means that a large majority of consumers are insured by companies that meet or exceed the MLR standard: 62% of consumers in the individual market; 83% in the small group market; and 89% in the large group market.
Individual Market
In the individual market, companies that did not meet the standard will pay $394 million in rebates to an estimated 2.6 million households this year.
The average rebate in the individual market is approximately $152 per family. Subscribers in Mississippi $651, Alabama $582, Maryland $496, and Delaware $461 are likely to see the highest rebates.
Small Group Market- Insurance Provided Through Small Employers
Over 1.8 million families, which include 3.3 million consumers enrolled in those policies, will see an average rebate of $174 provided to their employers in the small group market. Insurance companies in the small group market will issue $321 million in rebates this year.
The average rebate per family will be more than $500 in Alaska $622, Georgia $811, Illinois $551, New York $632, and Ohio $783.
Large Group Market- Insurance Provided Through Large Employers
Insurance companies in the large group market are expected to return $386 million in rebates. Generally these rebates will be paid directly to the employers to be distributed to their employees according to employees’ contributions to premium, benefiting approximately 2.9 million families or 5.3 million Americans. Though fewer companies in the large group market owe rebates, at a national level these companies are providing roughly the same dollar amount in terms of total rebates. This is because a larger number of consumers benefit from rebates in the large group market when compared to the individual or small group markets.
States whose health insurers have the highest average rebate in the large group market are Vermont $807, Oregon $777, Indiana $503, Colorado $475, Maine $463, and New Jersey $359.
For years, Americans have watched their premiums rise faster than their wages. Although these increases are partly due to rising medical costs and utilization of services, they are exacerbated by rising insurance company administrative costs including marketing and salaries of CEOs and profits, which contribute little or nothing to the care of patients or the health of consumers.
Many Americans are working hard to ensure that their families have health insurance coverage, and they do not deserve to have their premium dollars wasted on excessive administrative costs and profits. The Affordable Care Act and the 80/20 rule guarantee this right for consumers, and the over $1.1 billion in rebates provided through this rule show that insurance companies can no longer pass excessive administrative costs and profits on to consumers.
___________________________________________
There goes the 80/20 Rule as all of those consumer rebates took too much of that corporate profit! As you'll see below Obama simply tweaked the cap and added 2% more to administrative costs and allowed marketing to be excluded from the category of administrative costs.
So, one year out and loopholes appear that take away all of the consumer protection and drivers for lower insurance costs.
I read that the decline in rebates after just two years was the health industry response to 80/20.......
NO, THEY SIMPLY CHANGED WHAT WAS ADMINISTRATIVE AND TACKED ON 2%.
The 80/20 rule: Commissions vs. health premiums
This summer, 12.8 million Americans received over $1.1 billion in rebates from their insurers. | AP Photo
By TIMOTHY STOLTZFUS JOST | 9/18/12 9:39 PM EDT Updated: 9/19/12 3:51 PM EDT
Congress seems poised to throw out one of the most popular and effective provisions of the Affordable Care Act. But this move is not motivated just by political pique, it’s intended to protect the income of a special interest group. And some Democratic House members are helping Republicans do it.
This summer, 12.8 million Americans received more than $1.1 billion in rebates from their insurers. Small businesses received $321 million — money they can use to reduce their employees’ health insurance costs and expand their businesses. For many Americans, this is the most concrete evidence so far that health care reform is working for them.
These rebates were paid out under the act’s medical loss ratio — or 80/20 — rule, which requires insurers in the individual and small group market to spend 80 percent of their premiums on actual enrollee health care claims and programs to improve health care quality. The large group market must spend 85 percent on this. Insurers who miss the target had to pay a rebate.
But the rebates are not the most important benefit of the 80/20 rule. Strong evidence shows the rule is actually driving down premium increases for people and businesses. Health care costs have grown at record low rates since health reform was adopted. The 80/20 rule discourages insurers from raising premiums faster than the growth in health care costs — driving down the cost of insurance to consumers.
Yet Congress looks likely to eviscerate this rule to help a special interest group. One administrative cost that insurers must cover out of their 20 percent is marketing their products. This is usually done by insurance brokers and agents. Traditionally, agents and brokers have been paid through commissions based on a percentage of premiums, sometimes as high as 10 percent to 15 percent. As premiums have gone through the roof in recent years, commissions have grown apace.
____________________________________________
Here is our local Clinton neo-liberal toting the savings in Maryland. Maryland has one of the most expensive private and profit-driven health systems-----
Sarbanes is of course a Baltimore politician that not only allows widespread health industry fraud----but works for Johns Hopkins in their goal of having Maryland exempt from the oversight of Medicare for almost two decades while they privatized and created the tiered access to Medicare as ACA will in coming years. Sarbanes and Hopkins think that this Maryland plan that is the most private and profit-driven should be the model for the rest of the nation. Maryland's health exchange has one of the highest deductible rankings in the nation ----
Maryland and Guam are the only US regions seeking exemptions to Medicare.
Look at the deceptive promotion----its kind of like almost giving away smart phones because the fees and connections will soak you. Maryland has high deductibles and co-pays but will offer for now a lower premium.
Maryland issues insurance rates that are among lowest in U.S.
By Lena H. Sun July 26, 2013 Maryland insurance officials approved final rates Friday for health plans to be sold in the state’s new online marketplace that are among the lowest in the country. The plans, which are for individuals, will be sold beginning Oct. 1.
For some, Obamacare deductibles deliver sticker shock -
CBS Newswww.cbsnews.com/news/obamacare-deductibles-deliver-hefty... Cached
For some, Obamacare deductibles deliver sticker shock. Shares ... The average individual deductible for a bronze plan is a whopping $5,081 per year, ...
But there is always that rebate!
FOR IMMEDIATE RELEASE
Jun 21, 2012
Sarbanes Announces More Than $27 Million in Health Care Savings for People in Maryland
Sarbanes Announces More Than $27 Million in Health Care Savings for People in Maryland
Affordable Care Act provision requires health insurance companies to dedicate large portion of premiums to providing care and improving quality
WASHINGTON – U.S. Congressman John P. Sarbanes (D-Md.) today announced more than $27 million in health care savings for people in Maryland as a result of the Affordable Care Act 80/20 rule. These rebates will be distributed to more than 140,000 Marylanders and will result in an average rebate of $340 for each qualifying family.
“The health reform law ensures consumers a fair deal in return for the premiums they pay each month,” said Congressman Sarbanes, a member of the House Energy and Commerce Committee, which has jurisdiction over health care policy. “Insurance companies are now required to invest a reasonable amount of the premiums they collect in better health services and more access to care – not sink it in slick advertising, executive pay, and a healthy bottom line. Consumers will also have new tools to determine which insurers best limit administrative costs and invest in medical care.”
The Affordable Care Act 80/20 rule, also known as the Medical Loss Ratio (MLR) standard, requires insurance companies to spend at least 80 percent of consumers’ premium dollars on medical care and quality improvements.
Insurers can spend the remaining 20 percent on administrative costs, such as salaries, sales, and advertising. Beginning this year, insurers must notify customers how much of their premiums have been spent on medical care and quality improvement.
Insurance companies that do not meet the 80/20 standard must provide their policyholders a rebate for the difference no later than August 1st of this year.
_____________________________________________
Here we have yet more Republican posing as they could care less about saving consumers money. But what they are saying is true----the 80/20 Rule that was working for first year is already being filled with loopholes and in this case actually expanded by 2%. That does not sound like much---but it is.
As I stated above health corporations were already skirting the rule by moving costs that should have been administrative into the cost of care. Below you see one of the biggest administrative costs for health industry------marketing and this will find its way out of counting as administrative costs. You can bet these marketing costs were the driver of the initial rebates of $1.1 billion the first year.
Congresswoman: Obama admin rule change lets insurance companies keep more profits, pay less for care
12:44 PM 03/18/2014 2835 480 Patrick HowleyPolitical Reporter
“I am writing to express my concern with the proposed rule change released on Friday, March 14th that would allow insurance companies to keep an additional two percent of premiums for purposes other than medical care…your department is now proposing to increase the amount of money that insurance companies will be allowed to retain for profit,” Black wrote in a letter Tuesday to Health and Human Services (HHS) Secretary Kathleen Sebelius, which was obtained by The Daily Caller.
HHS’ Centers for Medicare and Medicaid Services quietly introduced the new rule Friday, which relieves insurance companies of some of the damage about to be levied on them by Obamacare-related administrative costs.
“In the proposed rules, you have indicated that this adjustment in the ‘medical loss ratio’, or 80/20 rule, is due to the possibility of increased administrative costs in 2015. However, adjusting the percentage that insurance providers are required to spend on medical care by two percent would have the combined impact of reducing the amount that insurance providers will be required to pay for people’s medical care while increasing the amount that insurance companies are allowed to retain for profit and for executive pay,” Black wrote.
“This is deeply concerning, as it could result in higher out of pocket costs for consumers solely for the benefit of the insurance industry.”
“If this rule were to take effect for 2015, what reasonable expectation can consumers have that it would be reversed in 2016 or later years?” Black wrote
__________________________________________
Notice that just as Obama and neo-liberals create this tiered private system of health plans with Medicaid and Bronze level being simply preventative care ------here come the corporate health plans to attach to this tiered system and what are wages today? Most people are at or near poverty. So, corporate health plans will send even more people to preventative care thanks to this Republican health policy with a goal to end public health!
Remember, the problem with health costs was massive and systemic health industry fraud and profiteering and the American people, after decades of paying into payroll taxes and having income taxes used to fund all of the medical research these health institutions now profit from WILL ONLY GET A TEE SHIRT!
EVERYBODY WILL BE MOVED TO PLANS THAT ARE MEDICAID OR BRONZE LEVEL. IF YOU CAN AFFORD SILVER OR PLATINUM TODAY----WAIT UNTIL THE NEXT ECONOMIC CRASH AND THE SOARING PRICES THAT COME FROM HEALTH MONOPOLIES!
US health industry is not worried about the end of public health----they have already built their global health tourism business and will cater to the world's rich. Johns Hopkins leads in health tourism while the citizens of Baltimore die 30 years below the longevity average because the Medicare and Medicaid that would have paid for health care to the poor built Hopkins' global campus. This is what Clinton global corporate neo-liberals work towards as they pass one Republican policy after another!
More Employers Moving to High-Deductible Health Plans
By cmtdpcjournal • November 29, 2014
By Karen Pallarito
HealthDay Reporter
FRIDAY, Aug. 15, 2014 (HealthDay News) – Many Americans with job-based health insurance will face costlier deductibles next year as more large employers embrace or expand so-called consumer-directed health plans, a new survey finds. The shift to high-deductible, consumer-directed health plans is occurring as Fortune 500 companies and large public-sector employers grapple with rising health-care and insurance costs.
“Employers are looking to put their employees in the driver’s seat” to help manage costs together, Brian Marcotte, president and CEO of the National Business Group on Health, said during a media briefing this week detailing the survey’s results.
Consumer-directed health plans feature high deductibles and low monthly premiums. These plans are typically paired with a health savings account to help employees and their dependents pay out-of-pocket medical expenses.
“The idea is that consumers will use fewer services and become more prudent purchasers since they bear more financial responsibility for their consumption,” said Caroline Pearson, a vice president at Avalere Health, a Washington, D.C.-based research and consulting firm.
Large employers are projecting a 6.5 percent increase in health-care costs in 2015, according to the survey. That’s slightly below the 7 percent increase employers had forecast for 2014, before adopting health plan design changes — such as moving to consumer-directed plans — and other cost containment measures.
Large employers said they hope to whittle next year’s projected increase to 5 percent. That’s about two-and-a-half times the annual U.S. inflation rate, which stood at 2.1 percent through the end of June.
Expensive medical claims, chronic diseases such as heart disease and cancer, as well as overall medical inflation are the main drivers of rising health costs, employers said in the survey.
“If you’re a large company that spends a half a billion dollars on health-care costs, a 5 percent increase is $25 million,” Marcotte said.
Consumer cost-sharing is also likely to rise by 5 percent in 2015, he said.
Along with shifting to consumer-directed health plans, more employers surveyed said they’ll encourage their health-plan participants to be better consumers and they’ll add or expand wellness programs.
....................................
__________________________________________
The US health industry has never been more profitable as the American people needing health care the most are systematically being denied access with the Affordable Care Act. Let's look at the other promise made to make the ACA seem as though it has any consumer value at all attached to it----capping the costs consumers will pay in a year.
This was going to save many people with chronic illness money and help the working class access the care they needed. The $6, 350 limit on out-of-pocket. Well, first it is delayed as we see below. But look closer.....what Obama and neo-liberals are doing is splitting into categories the cap limits instead of the overall health expenditure cap. This is what will kill consumers and make this entire cap policy yet one more propaganda tool.
They make this sound like a year delay but I have read drafts of the rules coming for 2015 and they appear to leave this cap limit set to separate categories. $6,600 cap but with varying categories.
A Limit on Consumer Costs Is Delayed in Health Care Law
By ROBERT PEAR Published: August 12, 2013 New York Times
WASHINGTON — In another setback for President Obama’s health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care.
The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014.
The grace period has been outlined on the Labor Department’s Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed. When asked in recent days about the language — which appeared as an answer to one of 137 “frequently asked questions about Affordable Care Act implementation” — department officials confirmed the policy.
The discovery is likely to fuel continuing Republican efforts this fall to discredit the president’s health care law.
Under the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.
Some consumers may have to pay even more, as some group health plans will not be required to impose any limit on a patient’s out-of-pocket costs for drugs next year. If a drug plan does not currently have a limit on out-of-pocket costs, it will not have to impose one for 2014, federal officials said Monday.
The health law, signed more than three years ago by Mr. Obama, clearly established a single overall limit on out-of-pocket costs for each individual or family. But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs.
In many cases, the companies have separate computer systems that cannot communicate with one another.
A senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: “We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person’s out-of-pocket costs. They asked for more time to comply.”
Health plans are free to set out-of-pocket limits lower than the levels allowed by the administration. But many employers and health plans sought the grace period, saying they needed time to upgrade their computer systems. “Benefit managers using different computer systems often cannot keep track of all the out-of-pocket costs incurred by a particular individual,” said Kathryn Wilber, a lawyer at the American Benefits Council, which represents many Fortune 500 companies that provide coverage to employees.
Last month the White House announced a one-year delay in enforcement of another major provision of the law, which requires larger employers to offer health coverage to full-time employees. Valerie Jarrett, Mr. Obama’s senior adviser, said that the delay of the employer mandate showed “we are listening” to businesses, which had complained about the complexity of federal reporting requirements.
Although the two delays are unrelated, together they underscore the difficulties the Obama administration is facing as it rolls out the health care law.
Advocates for people with chronic illnesses said they were dismayed by the policy decision on out-of-pocket costs.
“The government’s unexpected interpretation of the law will disproportionately harm people with complex chronic conditions and disabilities,” said Myrl Weinberg, the chief executive of the National Health Council, which speaks for more than 50 groups representing patients.
For people with serious illnesses like cancer and multiple sclerosis, Ms. Weinberg said, out-of-pocket costs can total tens of thousands of dollars a year.
Despite the delay, consumers in 2014 will still have many new protections. They cannot be denied health insurance or charged higher premiums because of pre-existing conditions, and many will qualify for subsidies intended to lower their costs.
In promoting his health care plan in 2009, Mr. Obama cited the limit on out-of-pocket costs as one of its chief virtues. “We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick,” Mr. Obama told a joint session of Congress in September 2009.
Advocates for patients said the promise of the law was being deferred. “We have wonderful new drugs, the biologics, to treat rheumatoid arthritis, but they are extremely expensive,” said Dr. Patience H. White, a vice president of the Arthritis Foundation. “In the past, patients had to live in constant pain, often became disabled and had to leave their jobs. The new drugs can make a huge difference, and we were hoping that the cap on out-of-pocket costs would make them affordable. But now many patients will have to wait another year.”
The American Cancer Society shares the concern and noted that some new cancer drugs cost $100,000 a year or more.
“If a prescription drug plan does not currently have a limit, then it will not have to have one in 2014,” said Molly Daniels, deputy president of the lobbying arm of the American Cancer Society. “Patients who require expensive drugs could continue to have enormous financial exposure, despite the clear intent of the law to limit a patient’s total out-of-pocket exposure.”
Federal officials said they were offering transition relief to certain health plans in 2014. But, they said, by 2015, health plans must comply with the law and must have an overall limit on out-of-pocket costs for medical, drug and other benefits combined.
Theodore M. Thompson, a vice president of the National Multiple Sclerosis Society, said: “The promise of out-of-pocket limits was one of the main reasons we supported health care reform. So we are disappointed that some plans will be allowed to have multiple out-of-pocket limits in 2014.”
The law also requires coverage of dental care for children, but these benefits can be offered in a separate health plan with its own limit on out-of-pocket costs.
Federal rules say that a free-standing dental plan must have “a reasonable annual limitation on cost-sharing.” In states where the new health insurance marketplace will be run by the federal government, the limit on out-of-pocket costs for pediatric dental benefits can be no more than $700 for coverage of one child and $1,400 for a plan covering two or more children in the same family.
_____________________________________________
Delayed Affordable Care Act Rules Ease Pressure on Employers, Attorney Says
Monday, July 15, 2013 from Human Resources Report inShare3 By Florence Olsen
Employers face an open enrollment period for 2014 under far less pressure because of a one-year delay of potential employer penalties under the Affordable Care Act, an ERISA Industry Committee (ERIC) vice president told BNA July 9.
Despite the delay, for which the Internal Revenue Service provided guidance July 9, employers subject to ACA's health coverage provisions still must provide information about affordability and minimum value requirements that apply to employer-provided health care coverage, according to Gretchen K. Young, ERIC's senior vice president for health policy in Washington, D.C.
But “the pressure is off” for a year in terms of employers being subject to excise tax penalties for having full-time employees who receive subsidized coverage in one of ACA's health insurance marketplaces, Young said.
Young said a Department of Health and Human Services final rule released July 5, which included procedures for the health insurance marketplaces to use in verifying individuals' access to employer-sponsored coverage, will further decrease the burden on employers subject to ACA's provisions.
As a consequence of the modified verification procedures described in the HHS final rule, more employees might receive subsidized health insurance coverage in 2014 than otherwise would have, but employers “will be less concerned because the subsidies won't trigger a penalty for 2014,” she said.
Because of the scaled-back verification process in the HHS final rule, employers also will receive fewer requests “for verifying employee attestations” about their eligibility for affordable, minimum value health insurance coverage from an employer, she said.
Notices to Employees
Employer notices to employees about enrollment options available through ACA's newly established health insurance marketplaces will not be affected by the one-year delay in employer reporting requirements under tax code sections 6055 and 6056 and a related delay of potential tax penalties under Section 4980H, Kathryn Wilber, senior counsel for health policy at the American Benefits Council (ABC) in Washington, D.C., told BNA July 9.
Wilber said those employee notices, due by Oct. 1, are outside the scope of the tax code provisions that the Treasury Department delayed. The notices must inform employees that they might be eligible for subsidized health insurance through the ACA marketplace if their employer's offer of coverage does not provide minimum value.
The notice requirement with respect to minimum value is somewhat unclear, Wilber said. However, she added, based on recent statements made by a Department of Labor official during a webinar sponsored by ABC, DOL wants the notices to be as useful as possible to employees.
“They would encourage employers to provide plan-specific information so that employees know whether their own plan provides minimum value,” Wilber said.
The one-year delay in enforcing ACA's employer shared-responsibility provisions was both welcome and disruptive, Amy M. Gordon, a partner at McDermott Will & Emery in Chicago, told BNA July 8.
Retail and other employers that had set up procedures for keeping track of hours worked by their variable hour employees in 2013 will have to discard the data already collected and start again in 2014, Gordon said.
The Affordable Care Act is so large because Obama and neo-liberals had to hide the fact that they are ending access to health care for 80% and climbing of American citizens and pushing them to a Medicaid preventative care only. This will include seniors as well as Medicare will be dismantled. Like the Financial Reform bill that was thousands of pages long-----and almost none of it implemented----the idea it to make the American people think there is something in there for them-----when there is absolutely nothing in the ACA for them. Remember, Trans Pacific Trade Pact pushes nations around the world to end their public health programs and this is what ACA does here in the US. It is a Republican policy to end public health and maximize health industry profits so don't listen to Republicans lamenting this attack on American's beloved Medicare----THEY WROTE THE POLICY FOR GOODNESS SAKE. They are playing the American people who will be literally killed from lack of access.
IF YOUR NATIONAL LABOR AND JUSTICE LEADERS SUPPORTED AFFORDABLE CARE ACT----THEY KNEW WHERE THIS WAS GOING. SO DID YOUR POLS!
GET RID OF THESE GLOBAL CORPORATE NEO-LIBERALS.
'Healthcare providers and consumer advocacy groups have complained about exchange health plans narrowing their networks to exclude a significant number of hospitals, physicians, clinics, and other providers. Plans say narrowing their networks is necessary to keep premiums affordable. The insurance industry and business groups are likely to view the new proposed rules with concern'.
Indeed, this 'narrowing' is exactly how these private health plans are going to maximize profit by excluding and making it difficult for many people to access the care they need. For example-----each plan must include pre-existing or chronic conditions but nothing says the plan cannot partner with a clinic two hours away to provide that care. Hospitals are partnering with certain insurance brands which may exclude by virtue of the high cost premiums creating a tiered system that will allow only affluent citizens access to some of the best hospitals. This was the goal of course as you can streamline operations better if access to care is income-based. In California, Illinois, and New York some of the top hospitals are now in narrow networks that allow only the affluent....and not coincidently those states are all Clinton global corporate neo-liberal. Nothing Democratic about class-specific health facilities. The rest of the world cannot believe this as nowhere else in the developed world does a government segregate health care according to income.
THAT'S WHAT A REPUBLICAN HEALTH PLAN DOES----WORKS FOR WEALTH AND POWER AND THAT IS WHAT THE AFFORDABLE CARE ACT IS ABOUT----CREATING THE WALL STREET OF HEALTH SYSTEM MONOPOLIES.
Below you see the first article that shows how all of the consumer-friendly policies in the ACA are being dismantled.The article shouts out how great this 80/20 Rule will be and I even had a Facebook discussion with someone supporting ACA and quoting this 80/20 Rule as 'putting money back into people's pockets'. Sounds great. Guess what health corporations did to respond to this early rebates of $1.1 billion------
THEY SIMPLY HID AND CREATED LOOPHOLES FOR WHAT IS CONSIDERED ADMINISTRATIVE.
All over the news was the splash------consumers getting hundreds of dollars back and today----you hear nothing because consumers are getting nothing back. It was all propaganda to make people think this wasn't all about maximizing profits for health industry.
Health insurers to pay rebates
Marylanders to get average of $143 per family
une 20, 2013|By Andrea K. Walker, The Baltimore Sun
The ACA 80/20 Rule: Provides Value and Rebates to Millions of Consumers
by Editorial Staff Jul 30 ,2012 1:15 am
The new health reform law, the Affordable Care Act, holds health insurance companies accountable to consumers and ensures that American families are reimbursed if health insurance companies don’t meet a fair standard of value.
Because of the Affordable Care Act, insurance companies now must reveal how much of premium dollars they actually spend on health care and how much they spend on administration, such as salaries and marketing. This information was not shared with consumers in the past. Not only is this information made available to consumers for the first time, if an insurance company spends less than 80% of premiums on medical care and quality or less than 85% in the large group market, which is generally insurance provided through large employers, it must rebate the portion of premium dollars that exceeded this limit. This 80/20 rule is commonly known as the Medical Loss Ratio MLR rule.
On June 1, 2012, insurance companies nationwide submitted their annual MLR reports for coverage provided in 2011 to the Department of Health and Human Services HHS. Based on this data, insurance companies that didn’t meet the 80/20 rule will provide nearly 12.8 million Americans with more than $1.1 billion in rebates this year. Americans receiving the rebate will benefit from an average rebate of $151 per household.
Under the new health care law, rebates must be paid by Aug. 1 each year. As a result, 12.8 million Americans will see one of the following:
- a rebate check in the mail
- a lump-sum reimbursement to the same account that was used to pay the premium if it was paid by credit card or debit card
- a direct reduction in their future premiums
- Their employer providing one of the above rebate methods, or applying the rebate in a manner that benefits its employees.
The 80/20 rule is ensuring that insurance companies provide consumers value for their premium dollars. This rule works in combination with other consumer protections in the Affordable Care Act, like the program that reviews insurance companies’ rates to ensure that premium increases are not unreasonable. Insurance companies are now required to subject insurance premium rate increases of 10% or more to a new review process and justify these increases. Most states now have the authority to determine whether these increases are excessive, while HHS reviews rates in states that do not operate effective rate review programs. In making these determinations: HHS and the states closely review insurance companies’ 80/20 or MLR standards.
Summary of All Markets
Americans covered by insurance companies that failed to meet the MLR standard will receive an average rebate of $151 per family across all markets. The average rebate per family is expected to be $152 in the individual market, $174 in the small group market, which is generally insurance provided through small employers, and $135 in the large group market. The states with average rebates above $500 per family are: Vermont $807, Oregon $777 and Indiana $503 in the large group market; Georgia $811, Ohio $783, New York $632, Alaska $622 and Illinois $551 in the small group market; and Mississippi $651 and Alabama $582 in the individual market.
Approximately 66.7 million consumers are insured by an insurance company that provides the required value for their premium dollars. This means that a large majority of consumers are insured by companies that meet or exceed the MLR standard: 62% of consumers in the individual market; 83% in the small group market; and 89% in the large group market.
Individual Market
In the individual market, companies that did not meet the standard will pay $394 million in rebates to an estimated 2.6 million households this year.
The average rebate in the individual market is approximately $152 per family. Subscribers in Mississippi $651, Alabama $582, Maryland $496, and Delaware $461 are likely to see the highest rebates.
Small Group Market- Insurance Provided Through Small Employers
Over 1.8 million families, which include 3.3 million consumers enrolled in those policies, will see an average rebate of $174 provided to their employers in the small group market. Insurance companies in the small group market will issue $321 million in rebates this year.
The average rebate per family will be more than $500 in Alaska $622, Georgia $811, Illinois $551, New York $632, and Ohio $783.
Large Group Market- Insurance Provided Through Large Employers
Insurance companies in the large group market are expected to return $386 million in rebates. Generally these rebates will be paid directly to the employers to be distributed to their employees according to employees’ contributions to premium, benefiting approximately 2.9 million families or 5.3 million Americans. Though fewer companies in the large group market owe rebates, at a national level these companies are providing roughly the same dollar amount in terms of total rebates. This is because a larger number of consumers benefit from rebates in the large group market when compared to the individual or small group markets.
States whose health insurers have the highest average rebate in the large group market are Vermont $807, Oregon $777, Indiana $503, Colorado $475, Maine $463, and New Jersey $359.
For years, Americans have watched their premiums rise faster than their wages. Although these increases are partly due to rising medical costs and utilization of services, they are exacerbated by rising insurance company administrative costs including marketing and salaries of CEOs and profits, which contribute little or nothing to the care of patients or the health of consumers.
Many Americans are working hard to ensure that their families have health insurance coverage, and they do not deserve to have their premium dollars wasted on excessive administrative costs and profits. The Affordable Care Act and the 80/20 rule guarantee this right for consumers, and the over $1.1 billion in rebates provided through this rule show that insurance companies can no longer pass excessive administrative costs and profits on to consumers.
___________________________________________
There goes the 80/20 Rule as all of those consumer rebates took too much of that corporate profit! As you'll see below Obama simply tweaked the cap and added 2% more to administrative costs and allowed marketing to be excluded from the category of administrative costs.
So, one year out and loopholes appear that take away all of the consumer protection and drivers for lower insurance costs.
I read that the decline in rebates after just two years was the health industry response to 80/20.......
NO, THEY SIMPLY CHANGED WHAT WAS ADMINISTRATIVE AND TACKED ON 2%.
The 80/20 rule: Commissions vs. health premiums
This summer, 12.8 million Americans received over $1.1 billion in rebates from their insurers. | AP Photo
By TIMOTHY STOLTZFUS JOST | 9/18/12 9:39 PM EDT Updated: 9/19/12 3:51 PM EDT
Congress seems poised to throw out one of the most popular and effective provisions of the Affordable Care Act. But this move is not motivated just by political pique, it’s intended to protect the income of a special interest group. And some Democratic House members are helping Republicans do it.
This summer, 12.8 million Americans received more than $1.1 billion in rebates from their insurers. Small businesses received $321 million — money they can use to reduce their employees’ health insurance costs and expand their businesses. For many Americans, this is the most concrete evidence so far that health care reform is working for them.
These rebates were paid out under the act’s medical loss ratio — or 80/20 — rule, which requires insurers in the individual and small group market to spend 80 percent of their premiums on actual enrollee health care claims and programs to improve health care quality. The large group market must spend 85 percent on this. Insurers who miss the target had to pay a rebate.
But the rebates are not the most important benefit of the 80/20 rule. Strong evidence shows the rule is actually driving down premium increases for people and businesses. Health care costs have grown at record low rates since health reform was adopted. The 80/20 rule discourages insurers from raising premiums faster than the growth in health care costs — driving down the cost of insurance to consumers.
Yet Congress looks likely to eviscerate this rule to help a special interest group. One administrative cost that insurers must cover out of their 20 percent is marketing their products. This is usually done by insurance brokers and agents. Traditionally, agents and brokers have been paid through commissions based on a percentage of premiums, sometimes as high as 10 percent to 15 percent. As premiums have gone through the roof in recent years, commissions have grown apace.
____________________________________________
Here is our local Clinton neo-liberal toting the savings in Maryland. Maryland has one of the most expensive private and profit-driven health systems-----
Sarbanes is of course a Baltimore politician that not only allows widespread health industry fraud----but works for Johns Hopkins in their goal of having Maryland exempt from the oversight of Medicare for almost two decades while they privatized and created the tiered access to Medicare as ACA will in coming years. Sarbanes and Hopkins think that this Maryland plan that is the most private and profit-driven should be the model for the rest of the nation. Maryland's health exchange has one of the highest deductible rankings in the nation ----
Maryland and Guam are the only US regions seeking exemptions to Medicare.
Look at the deceptive promotion----its kind of like almost giving away smart phones because the fees and connections will soak you. Maryland has high deductibles and co-pays but will offer for now a lower premium.
Maryland issues insurance rates that are among lowest in U.S.
By Lena H. Sun July 26, 2013 Maryland insurance officials approved final rates Friday for health plans to be sold in the state’s new online marketplace that are among the lowest in the country. The plans, which are for individuals, will be sold beginning Oct. 1.
For some, Obamacare deductibles deliver sticker shock -
CBS Newswww.cbsnews.com/news/obamacare-deductibles-deliver-hefty... Cached
For some, Obamacare deductibles deliver sticker shock. Shares ... The average individual deductible for a bronze plan is a whopping $5,081 per year, ...
But there is always that rebate!
FOR IMMEDIATE RELEASE
Jun 21, 2012
Sarbanes Announces More Than $27 Million in Health Care Savings for People in Maryland
Sarbanes Announces More Than $27 Million in Health Care Savings for People in Maryland
Affordable Care Act provision requires health insurance companies to dedicate large portion of premiums to providing care and improving quality
WASHINGTON – U.S. Congressman John P. Sarbanes (D-Md.) today announced more than $27 million in health care savings for people in Maryland as a result of the Affordable Care Act 80/20 rule. These rebates will be distributed to more than 140,000 Marylanders and will result in an average rebate of $340 for each qualifying family.
“The health reform law ensures consumers a fair deal in return for the premiums they pay each month,” said Congressman Sarbanes, a member of the House Energy and Commerce Committee, which has jurisdiction over health care policy. “Insurance companies are now required to invest a reasonable amount of the premiums they collect in better health services and more access to care – not sink it in slick advertising, executive pay, and a healthy bottom line. Consumers will also have new tools to determine which insurers best limit administrative costs and invest in medical care.”
The Affordable Care Act 80/20 rule, also known as the Medical Loss Ratio (MLR) standard, requires insurance companies to spend at least 80 percent of consumers’ premium dollars on medical care and quality improvements.
Insurers can spend the remaining 20 percent on administrative costs, such as salaries, sales, and advertising. Beginning this year, insurers must notify customers how much of their premiums have been spent on medical care and quality improvement.
Insurance companies that do not meet the 80/20 standard must provide their policyholders a rebate for the difference no later than August 1st of this year.
_____________________________________________
Here we have yet more Republican posing as they could care less about saving consumers money. But what they are saying is true----the 80/20 Rule that was working for first year is already being filled with loopholes and in this case actually expanded by 2%. That does not sound like much---but it is.
As I stated above health corporations were already skirting the rule by moving costs that should have been administrative into the cost of care. Below you see one of the biggest administrative costs for health industry------marketing and this will find its way out of counting as administrative costs. You can bet these marketing costs were the driver of the initial rebates of $1.1 billion the first year.
Congresswoman: Obama admin rule change lets insurance companies keep more profits, pay less for care
12:44 PM 03/18/2014 2835 480 Patrick HowleyPolitical Reporter
- Patrick HowleyPatrick Howley is an investigative reporter for The Daily Caller.
“I am writing to express my concern with the proposed rule change released on Friday, March 14th that would allow insurance companies to keep an additional two percent of premiums for purposes other than medical care…your department is now proposing to increase the amount of money that insurance companies will be allowed to retain for profit,” Black wrote in a letter Tuesday to Health and Human Services (HHS) Secretary Kathleen Sebelius, which was obtained by The Daily Caller.
HHS’ Centers for Medicare and Medicaid Services quietly introduced the new rule Friday, which relieves insurance companies of some of the damage about to be levied on them by Obamacare-related administrative costs.
“In the proposed rules, you have indicated that this adjustment in the ‘medical loss ratio’, or 80/20 rule, is due to the possibility of increased administrative costs in 2015. However, adjusting the percentage that insurance providers are required to spend on medical care by two percent would have the combined impact of reducing the amount that insurance providers will be required to pay for people’s medical care while increasing the amount that insurance companies are allowed to retain for profit and for executive pay,” Black wrote.
“This is deeply concerning, as it could result in higher out of pocket costs for consumers solely for the benefit of the insurance industry.”
“If this rule were to take effect for 2015, what reasonable expectation can consumers have that it would be reversed in 2016 or later years?” Black wrote
__________________________________________
Notice that just as Obama and neo-liberals create this tiered private system of health plans with Medicaid and Bronze level being simply preventative care ------here come the corporate health plans to attach to this tiered system and what are wages today? Most people are at or near poverty. So, corporate health plans will send even more people to preventative care thanks to this Republican health policy with a goal to end public health!
Remember, the problem with health costs was massive and systemic health industry fraud and profiteering and the American people, after decades of paying into payroll taxes and having income taxes used to fund all of the medical research these health institutions now profit from WILL ONLY GET A TEE SHIRT!
EVERYBODY WILL BE MOVED TO PLANS THAT ARE MEDICAID OR BRONZE LEVEL. IF YOU CAN AFFORD SILVER OR PLATINUM TODAY----WAIT UNTIL THE NEXT ECONOMIC CRASH AND THE SOARING PRICES THAT COME FROM HEALTH MONOPOLIES!
US health industry is not worried about the end of public health----they have already built their global health tourism business and will cater to the world's rich. Johns Hopkins leads in health tourism while the citizens of Baltimore die 30 years below the longevity average because the Medicare and Medicaid that would have paid for health care to the poor built Hopkins' global campus. This is what Clinton global corporate neo-liberals work towards as they pass one Republican policy after another!
More Employers Moving to High-Deductible Health Plans
By cmtdpcjournal • November 29, 2014
By Karen Pallarito
HealthDay Reporter
FRIDAY, Aug. 15, 2014 (HealthDay News) – Many Americans with job-based health insurance will face costlier deductibles next year as more large employers embrace or expand so-called consumer-directed health plans, a new survey finds. The shift to high-deductible, consumer-directed health plans is occurring as Fortune 500 companies and large public-sector employers grapple with rising health-care and insurance costs.
“Employers are looking to put their employees in the driver’s seat” to help manage costs together, Brian Marcotte, president and CEO of the National Business Group on Health, said during a media briefing this week detailing the survey’s results.
Consumer-directed health plans feature high deductibles and low monthly premiums. These plans are typically paired with a health savings account to help employees and their dependents pay out-of-pocket medical expenses.
“The idea is that consumers will use fewer services and become more prudent purchasers since they bear more financial responsibility for their consumption,” said Caroline Pearson, a vice president at Avalere Health, a Washington, D.C.-based research and consulting firm.
Large employers are projecting a 6.5 percent increase in health-care costs in 2015, according to the survey. That’s slightly below the 7 percent increase employers had forecast for 2014, before adopting health plan design changes — such as moving to consumer-directed plans — and other cost containment measures.
Large employers said they hope to whittle next year’s projected increase to 5 percent. That’s about two-and-a-half times the annual U.S. inflation rate, which stood at 2.1 percent through the end of June.
Expensive medical claims, chronic diseases such as heart disease and cancer, as well as overall medical inflation are the main drivers of rising health costs, employers said in the survey.
“If you’re a large company that spends a half a billion dollars on health-care costs, a 5 percent increase is $25 million,” Marcotte said.
Consumer cost-sharing is also likely to rise by 5 percent in 2015, he said.
Along with shifting to consumer-directed health plans, more employers surveyed said they’ll encourage their health-plan participants to be better consumers and they’ll add or expand wellness programs.
....................................
__________________________________________
The US health industry has never been more profitable as the American people needing health care the most are systematically being denied access with the Affordable Care Act. Let's look at the other promise made to make the ACA seem as though it has any consumer value at all attached to it----capping the costs consumers will pay in a year.
This was going to save many people with chronic illness money and help the working class access the care they needed. The $6, 350 limit on out-of-pocket. Well, first it is delayed as we see below. But look closer.....what Obama and neo-liberals are doing is splitting into categories the cap limits instead of the overall health expenditure cap. This is what will kill consumers and make this entire cap policy yet one more propaganda tool.
They make this sound like a year delay but I have read drafts of the rules coming for 2015 and they appear to leave this cap limit set to separate categories. $6,600 cap but with varying categories.
A Limit on Consumer Costs Is Delayed in Health Care Law
By ROBERT PEAR Published: August 12, 2013 New York Times
WASHINGTON — In another setback for President Obama’s health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care.
The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014.
The grace period has been outlined on the Labor Department’s Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed. When asked in recent days about the language — which appeared as an answer to one of 137 “frequently asked questions about Affordable Care Act implementation” — department officials confirmed the policy.
The discovery is likely to fuel continuing Republican efforts this fall to discredit the president’s health care law.
Under the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.
Some consumers may have to pay even more, as some group health plans will not be required to impose any limit on a patient’s out-of-pocket costs for drugs next year. If a drug plan does not currently have a limit on out-of-pocket costs, it will not have to impose one for 2014, federal officials said Monday.
The health law, signed more than three years ago by Mr. Obama, clearly established a single overall limit on out-of-pocket costs for each individual or family. But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs.
In many cases, the companies have separate computer systems that cannot communicate with one another.
A senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: “We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person’s out-of-pocket costs. They asked for more time to comply.”
Health plans are free to set out-of-pocket limits lower than the levels allowed by the administration. But many employers and health plans sought the grace period, saying they needed time to upgrade their computer systems. “Benefit managers using different computer systems often cannot keep track of all the out-of-pocket costs incurred by a particular individual,” said Kathryn Wilber, a lawyer at the American Benefits Council, which represents many Fortune 500 companies that provide coverage to employees.
Last month the White House announced a one-year delay in enforcement of another major provision of the law, which requires larger employers to offer health coverage to full-time employees. Valerie Jarrett, Mr. Obama’s senior adviser, said that the delay of the employer mandate showed “we are listening” to businesses, which had complained about the complexity of federal reporting requirements.
Although the two delays are unrelated, together they underscore the difficulties the Obama administration is facing as it rolls out the health care law.
Advocates for people with chronic illnesses said they were dismayed by the policy decision on out-of-pocket costs.
“The government’s unexpected interpretation of the law will disproportionately harm people with complex chronic conditions and disabilities,” said Myrl Weinberg, the chief executive of the National Health Council, which speaks for more than 50 groups representing patients.
For people with serious illnesses like cancer and multiple sclerosis, Ms. Weinberg said, out-of-pocket costs can total tens of thousands of dollars a year.
Despite the delay, consumers in 2014 will still have many new protections. They cannot be denied health insurance or charged higher premiums because of pre-existing conditions, and many will qualify for subsidies intended to lower their costs.
In promoting his health care plan in 2009, Mr. Obama cited the limit on out-of-pocket costs as one of its chief virtues. “We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick,” Mr. Obama told a joint session of Congress in September 2009.
Advocates for patients said the promise of the law was being deferred. “We have wonderful new drugs, the biologics, to treat rheumatoid arthritis, but they are extremely expensive,” said Dr. Patience H. White, a vice president of the Arthritis Foundation. “In the past, patients had to live in constant pain, often became disabled and had to leave their jobs. The new drugs can make a huge difference, and we were hoping that the cap on out-of-pocket costs would make them affordable. But now many patients will have to wait another year.”
The American Cancer Society shares the concern and noted that some new cancer drugs cost $100,000 a year or more.
“If a prescription drug plan does not currently have a limit, then it will not have to have one in 2014,” said Molly Daniels, deputy president of the lobbying arm of the American Cancer Society. “Patients who require expensive drugs could continue to have enormous financial exposure, despite the clear intent of the law to limit a patient’s total out-of-pocket exposure.”
Federal officials said they were offering transition relief to certain health plans in 2014. But, they said, by 2015, health plans must comply with the law and must have an overall limit on out-of-pocket costs for medical, drug and other benefits combined.
Theodore M. Thompson, a vice president of the National Multiple Sclerosis Society, said: “The promise of out-of-pocket limits was one of the main reasons we supported health care reform. So we are disappointed that some plans will be allowed to have multiple out-of-pocket limits in 2014.”
The law also requires coverage of dental care for children, but these benefits can be offered in a separate health plan with its own limit on out-of-pocket costs.
Federal rules say that a free-standing dental plan must have “a reasonable annual limitation on cost-sharing.” In states where the new health insurance marketplace will be run by the federal government, the limit on out-of-pocket costs for pediatric dental benefits can be no more than $700 for coverage of one child and $1,400 for a plan covering two or more children in the same family.
_____________________________________________
Delayed Affordable Care Act Rules Ease Pressure on Employers, Attorney Says
Monday, July 15, 2013 from Human Resources Report inShare3 By Florence Olsen
Employers face an open enrollment period for 2014 under far less pressure because of a one-year delay of potential employer penalties under the Affordable Care Act, an ERISA Industry Committee (ERIC) vice president told BNA July 9.
Despite the delay, for which the Internal Revenue Service provided guidance July 9, employers subject to ACA's health coverage provisions still must provide information about affordability and minimum value requirements that apply to employer-provided health care coverage, according to Gretchen K. Young, ERIC's senior vice president for health policy in Washington, D.C.
But “the pressure is off” for a year in terms of employers being subject to excise tax penalties for having full-time employees who receive subsidized coverage in one of ACA's health insurance marketplaces, Young said.
Young said a Department of Health and Human Services final rule released July 5, which included procedures for the health insurance marketplaces to use in verifying individuals' access to employer-sponsored coverage, will further decrease the burden on employers subject to ACA's provisions.
As a consequence of the modified verification procedures described in the HHS final rule, more employees might receive subsidized health insurance coverage in 2014 than otherwise would have, but employers “will be less concerned because the subsidies won't trigger a penalty for 2014,” she said.
Because of the scaled-back verification process in the HHS final rule, employers also will receive fewer requests “for verifying employee attestations” about their eligibility for affordable, minimum value health insurance coverage from an employer, she said.
Notices to Employees
Employer notices to employees about enrollment options available through ACA's newly established health insurance marketplaces will not be affected by the one-year delay in employer reporting requirements under tax code sections 6055 and 6056 and a related delay of potential tax penalties under Section 4980H, Kathryn Wilber, senior counsel for health policy at the American Benefits Council (ABC) in Washington, D.C., told BNA July 9.
Wilber said those employee notices, due by Oct. 1, are outside the scope of the tax code provisions that the Treasury Department delayed. The notices must inform employees that they might be eligible for subsidized health insurance through the ACA marketplace if their employer's offer of coverage does not provide minimum value.
The notice requirement with respect to minimum value is somewhat unclear, Wilber said. However, she added, based on recent statements made by a Department of Labor official during a webinar sponsored by ABC, DOL wants the notices to be as useful as possible to employees.
“They would encourage employers to provide plan-specific information so that employees know whether their own plan provides minimum value,” Wilber said.
The one-year delay in enforcing ACA's employer shared-responsibility provisions was both welcome and disruptive, Amy M. Gordon, a partner at McDermott Will & Emery in Chicago, told BNA July 8.
Retail and other employers that had set up procedures for keeping track of hours worked by their variable hour employees in 2013 will have to discard the data already collected and start again in 2014, Gordon said.
RSS Feed
