ACA ObamaCare 2018 - Rules, Premiums, Info, Etc.

Discussion in 'Health Care Reform Forum' started by AllenChicago, Apr 19, 2017.

  1. AllenChicago
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    AllenChicago Well-Known Member

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    April 18, 2017

    This is an emotionally difficult thread to start, because this year started with Republicans in control of the House, Senate, and White House. After 6 years of campaigning on making ObamaCare REPEAL their #1 Priority, I fully expected that ACA-ObamaCare would not be in existence after 12/31/2017.

    But, as of right now, their Repeal efforts has failed miserably, and HHS Secretary Tom Price is busy issuing Rules and Directives designed to "shore up" the ACA-ObamaCare market for 2018.
    :no:

    Below is a copy/paste Summary of the first 2018 Rule. It arrived from via E-mail from HHS today.

    (Note the "tone" with which this is worded. You'd never see this in an e-mail from Obama's HHS.)


    Title: MARKET STABILIZATION rule.

    The Centers for Medicare & Medicaid Services (CMS) issued the final Market Stabilization rule to help lower premiums and stabilize individual and small group markets, and to increase choices for Americans.

    Individuals obtaining coverage in the Marketplace created by the Affordable Care Act have faced double-digit premium increases, fewer plans to choose from, and a market that continues to be threatened by insurance issuer exits. The CMS rule is designed to provide some relief for patients and issuers.

    “CMS is committed to ensuring access to high quality affordable healthcare for all Americans and these actions are necessary to increase patient choices and to lower premiums,” said CMS Administrator Seema Verma. “While these steps will help stabilize the individual and small group markets, they are not a long-term cure for the problems that the Affordable Care Act has created in our healthcare system.”

    The final rule makes several policy changes to improve the market and promote stability, including:

    2018 Annual Open Enrollment Period: The final rule adjusts the annual Open Enrollment period for 2018 to more closely align with Medicare and the private market. The next Open Enrollment period will start on November 1, 2017 and run through December 15, 2017, encouraging individuals to enroll in coverage prior to the beginning of the year.

    Reduce Fraud, Waste, and Abuse: The final rule promotes program integrity by requiring individuals to submit supporting documentation for special enrollment periods and ensures that only those who are eligible are able to enroll. It will encourage individuals to stay enrolled in coverage all year, reducing gaps in coverage and resulting in fewer individual mandate penalties and helping to lower premiums.

    Promote Continuous Coverage: The final rule promotes personal responsibility by allowing issuers to require individuals to pay back past due premiums before enrolling into a plan with the same issuer the following year. This is intended to address gaming and encourage individuals to maintain continuous coverage throughout the year, which will have a positive impact on the risk pool.

    Ensure More Choices for Consumers: For the 2018 plan year and beyond, the final rule allows issuers additional actuarial value flexibility to develop more choices with lower premium options for consumers, and to continue offering existing plans.

    Empower States & Reduce Duplication: The final rule reduces waste of taxpayer dollars by eliminating duplicative review of network adequacy by the Federal Government. The rule returns oversight of network adequacy to states, which are best positioned to evaluate network adequacy.

    CMS also made a number of other announcements regarding the process that issuers must follow to meet the law’s requirements for the 2018 plan year. The additional guidance released includes updates to make the guidance consistent with the final rule and provide information needed by issuers in order to have their plans certified for 2018, including: Key Dates for 2017; Issuer Guidance on Uniform Rate Review Timeline; Good Faith Compliance Guidance; QHP Certification Guidance for States; and Final Actuarial Value (AV) Calculator for 2018 and Methodology.

    The final rule can be found, here: https://www.federalregister.gov/doc...-and-affordable-care-act-market-stabilization

    *Recent statistics related to the Affordable Care Act:

    •Approximately one-third of counties in the U.S. have only one insurer participating in their exchange for 2017.

    •Five states have only one insurer participating in their exchange for 2017.

    •The premium for the benchmark second-lowest cost “silver plan” on HealthCare.gov increased by an average of 25 percent from 2016-2017.

    •Approximately 500,000 fewer Americans selected a plan in the exchange open enrollment in 2017 than in 2016.

    •Many states saw double digit increases in their insurance premiums including:

    - AZ: 116%
    - OK: 69%
    - TN: 63%
    - AL: 58%
    - PA: 53%

    -END of Copy/Paste

    As usual, I'll add more useful, relevant info to this thread as it's discovered.

    Disgusted,
    -Allen

    ----------Story #2 for Today-----------

    Executives from America's Health Insurance Plans, the Blue Cross Blue Shield Association, and from Molina Healthcare, Oscar Health, Kaiser Permanente, Geisinger Health Plan and Tufts Health Plan met with HHS-CMS today.

    Sounds like it was a wasted trip, because Cost Sharing Reduction payments from Uncle Sam to Health Insurers, may be going away, in-spite of their pleas.

    Full Story: https://www.washingtonpost.com/news...are-they-didnt-get-it/?utm_term=.577053794d82
     
  2. bill3173
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    bill3173 Well-Known Member

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    Promote Continuous Coverage: The final rule promotes personal responsibility by allowing issuers to require individuals to pay back past due premiums before enrolling into a plan with the same issuer the following year. This is intended to address gaming and encourage individuals to maintain continuous coverage throughout the year, which will have a positive impact on the risk pool.

    This sounds like if you stop paying mid year, you're going to knock yourself out of coverage for the following year, unless you back pay. That's a tough one, particularly off exchange, where the back pay could be 1000's. This is actually a terrible rule, since it's easier to pay the penalty for most people.

    Back paying would be more likely for someone with a serious medical condition, or an "up coming" surgery. I don't see how this is going to lower costs.
     
  3. kgmom219
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    kgmom219 Well-Known Member

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    Nothing proposed so far is going to actually lower costs.

    We need the 5% in their own (subsidized) pool for 10 years (I'm guessing, I'm not an actuary) and pre ex based on HIPAA.
     
  4. Yagents
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    Yagents Well-Known Member

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    You only have to pay back premium if u go with same carrier again the following year. Becomes difficult to game when you have only 1 carrier though. This won't effect multi carrier states.

    ----------

    Most of these rules are targeting fraud which is good for a 5%-10% premium reduction.

    ----------

    Csr is a bargaining chip to get Dems to table. Pubs will fund csr, as they know they own the collapse if not. No worries, just enjoy the game of chicken
     
  5. papercutter
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    papercutter Well-Known Member

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    Donald Trump was given one important assignment to take care of when he was elected, just one, to fix the Obamacare disaster and he has failed spectacularly at that. How did this bumbling clown ever become a billionaire anyway, when he can't even perform one g-damn task?!
     
  6. Yagents
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    Yagents Well-Known Member

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    It was not a 1 issue election...........moving on........timeline for plan submission attached.
     

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  7. RayNY
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    RayNY Well-Known Member

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    If he just dumped the money he got from his father into an index fund, he'd be worth roughly three times as much as he currently is.

    His companies lag far behind the market average, and even further behind his industry competitors. He's not some business genius, he's a guy that had everything handed to him and just hasn't screwed it up too badly.
     
  8. traceyemoon
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    traceyemoon Well-Known Member

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    Funny that one listing on the timeline is the number of days that the FFE will stop crashing at the start of OpenEnrollment. Three days last year and enrollees had to submit documentation that they did, in fact, enroll during those days. marketplace reps opened a case with "tier two" reps.

    It's like a bizzaro-world Monty Python sketch.
     
  9. VolAgent
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    VolAgent Well-Known Member

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    Somehow he managed to develop a cult of personality back in the 80s and has ridden it every since.
     
  10. kgmom219
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    kgmom219 Well-Known Member

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    Anyone else notice that the "Target Date" is 11/1? Guess we won't get a rate preview again.....
     
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